Body weight changes with beta-blocker use: results from GEMINI

Am J Med. 2007 Jul;120(7):610-5. doi: 10.1016/j.amjmed.2006.10.017.


Purpose: Patients with type 2 diabetes are commonly overweight, which can contribute to poor cardiovascular outcomes. beta-blockers may promote weight gain, or hamper weight loss, and are a concern in high-risk patients. The current analysis of the Glycemic Effect in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial evaluates the effects of carvedilol and metoprolol tartrate on weight gain in patients with type 2 diabetes and hypertension.

Methods: This prespecified secondary analysis of the GEMINI study (n=1106) evaluated change in body weight after 5 months.

Results: Mean (+/-SE) baseline weights were 97.5 (+/-20.1) kg for carvedilol and 96.6 (+/-20.1) kg for metoprolol tartrate. Treatment difference (c vs m) in mean (+/-SE) weight change from baseline was -1.02 (+/-0.21) kg (95% confidence interval [CI], -1.43 to -0.60; P <.001). Patients taking metoprolol had a significant mean (+/-SE) weight gain of 1.19 (+/-0.16) kg (P <.001); patients taking carvedilol did not (0.17 [+/-0.19] kg; P =.36). Metoprolol tartrate-treated patients with body mass index (BMI) >30 kg/m2 had a statistically significant greater weight gain than comparable carvedilol-treated patients. Treatment differences (c vs m) in the obese (BMI >30 kg/m2) and morbidly obese groups (BMI >40 kg/m2) were -0.90 kg (95% CI, -1.5 to -0.3; P =.002) and -1.84 kg (95% CI, -2.9 to -0.8; P =.001), respectively. Pairwise correlation analyses revealed no significant associations between weight change and change in HbA1c, HOMA-IR, or blood pressure.

Conclusions: Metoprolol tartrate was associated with increased weight gain compared to carvedilol; weight gain was most pronounced in subjects with hypertension and diabetes who were not taking insulin therapy.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / pharmacology*
  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / pharmacology*
  • Antihypertensive Agents / therapeutic use
  • Body Weight / drug effects
  • Carbazoles / pharmacology
  • Carbazoles / therapeutic use
  • Carvedilol
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Double-Blind Method
  • Female
  • Humans
  • Hypertension / drug therapy*
  • Male
  • Metoprolol / pharmacology
  • Metoprolol / therapeutic use
  • Middle Aged
  • Propanolamines / pharmacology
  • Propanolamines / therapeutic use
  • Prospective Studies


  • Adrenergic beta-Antagonists
  • Antihypertensive Agents
  • Carbazoles
  • Propanolamines
  • Carvedilol
  • Metoprolol