Betablocker treatment in diabetes mellitus

J Intern Med. 2001 Jul;250(1):11-7. doi: 10.1046/j.1365-2796.2001.00829.x.


Objectives: Betablockers have been convincingly shown to reduce total and cardiovascular morbidity and mortality of hypertensive diabetic patients. In diabetic patients, after myocardial infarction, these agents confer a twice as high protective effect when compared to non-diabetic patients. However, most paradoxically, betablocking agents are used less frequently in diabetes. Control of hypertension is insufficient in most of the diabetic patients, probably because a combination of antihypertensive agents including betablockers is frequently needed to sufficiently control blood pressure but is not used in these patients. The fear of betablocker-associated side effects in diabetes may be partly responsible for the frequent antihypertensive mono-therapy and the resulting poor quality of blood pressure control among diabetic patients.

Design: We have performed an analysis of the literature to assess whether possible adverse metabolic effects, a higher risk of hypoglycaemia or less nephroprotective effects of beta1-selective betablocking agents could justify the reticence in prescribing these antihypertensive agents to diabetic patients.

Results: A thorough review of the literature does not indicate that beta1-selective betablocking agents have important adverse effects on glucose metabolism, prolong hypoglycaemia or mask hypoglycaemic symptoms. In diabetic nephropathy, betablockers are as nephroprotective as angiotensin converting enzyme inhibitors.

Conclusions: The unnecessary less frequent prescription of beta1-selective betablockers in diabetes mellitus may contribute to the higher cardiovascular mortality among these patients.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-1 Receptor Antagonists*
  • Adrenergic beta-Antagonists / administration & dosage*
  • Adrenergic beta-Antagonists / adverse effects
  • Blood Glucose / metabolism
  • Diabetes Complications*
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / drug therapy
  • Humans
  • Hypertension / blood
  • Hypertension / complications
  • Hypertension / drug therapy*
  • Hypoglycemia / blood
  • Hypoglycemia / chemically induced
  • Risk


  • Adrenergic beta-1 Receptor Antagonists
  • Adrenergic beta-Antagonists
  • Blood Glucose