Diabetes adrenoceptor antagonists

In the treatment of hypertension, ACE inhibitors are as effective as diuretics, (3-adrenoceptor antagonists, or calcium channel blockers in lowering blood pressure. However, increased survival rates have only been demonstrated for diuretics and (3-adrenoceptor antagonists. ACE inhibitors are approved for monotherapy as well as for combinational regimes. ACE inhibitors are the dtugs of choice for the treatment of hypertension with renal diseases, particularly diabetic nephropathy, because they prevent the progression of renal failure and improve proteinuria more efficiently than the other diugs. 

However, contrary to popular belief, beta-adrenoceptor antagonists do not by themselves increase the risk of hypoglycemic episodes in insulin-treated diabetics, in whom their use was concluded to be generally safe (192). Indeed, in 20 such patients treated with diet or diet plus oral hypoglycemic agents, both propranolol and metoprolol produced small but significant increases in blood... 

The principal toxicities of propranolol result from blockade of cardiac, vascular, or bronchial 6-receptors and are described in more detail in Chapter 10 Adrenoceptor Antagonist Drugs. The most important of these predictable extensions of the 6-blocking action occur in patients with bradycardia or cardiac conduction disease, asthma, peripheral vascular insufficiency, and diabetes. 

Activation of a2-adrenoceptors in pancreatic p-cells inhibits insulin release, and this effect is blocked by 0C2 adrenoceptor antagonists (Angel and Langer. 1988 Lorrain et al. 1992). A peripherally active 0C2 adrenoceptor antagonist, SL 84.0148, was developed for the treatment of type 11 diabetes (Angel et al. 1992 1996) but was abandoned in Phase 11 (S.Z. Langer, unpublished). 

Secondary hyperlipidaemias results from liver and biliary disease, obesity, hypothyroidism, diabetes, diet, alcohol excess, renal disease (nephrotic syndrome) and drugs (including etretinate, HIV protease ir hibitors, thiazide diuretics, oral contraceptive steroids, glucorticosteroids, (3-adrenoceptor antagonists, ciclosporin). 

Using the African American Study of Kidney Disease and Hypertension (AASK) database, non-diabetic adults were randomly assigned to ACE inhibitors, beta adrenoceptor antagonists, or calcium channel blockers [42 ]. Hjq)erkalemia was associated with a reduced glomerular filtration rate (below 41 ml/minute/1.73 m ). Hjq)erkalemia was also significantly more common with ACE inhibitors. The use of a potassium-wasting diuretic was associated with a 59% reduction in the risk of hyperkalemia. 

---