Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension. A randomized, controlled trial

Ann Intern Med. 1997 Jun 15;126(12):955-9. doi: 10.7326/0003-4819-126-12-199706150-00004.


Background: Diabetic patients are considered less suitable than nondiabetic patients for beta-blocker therapy because of the risk for worsened glucose and lipid metabolism and more severe hypoglycemic attacks.

Objective: To compare the metabolic and cardiovascular effects of carvedilol with those of atenolol in diabetic patients with hypertension.

Design: Randomized, double-blind, 24-week trial.

Setting: University hospital clinic.

Patients: 45 patients with non-insulin-dependent diabetes mellitus and hypertension.

Intervention: After a 4- to 6-week run-in period during which placebo was given in a single-blind manner, patients were randomly assigned to carvedilol or atenolol.

Measurements: An oral glucose tolerance test; assessment of insulin sensitivity and hormonal responses to insulin hypoglycemia; and assessment of lipid levels, blood pressure, left ventricular mass, and lipid peroxidation.

Results: Changes in systolic and diastolic blood pressure and left ventricular mass index were similar with carvedilol and atenolol (P > 0.2). Fasting plasma glucose and insulin levels decreased with carvedilol and increased with atenolol. Responses to carvedilol were greater than those to atenolol, as follows: increase in total glucose disposal, 9.54 mumol/kg of body weight per minute (95% CI, 7 to 11.9 mumol/kg per minute); decrease in plasma glucose response to oral glucose, 61 mmol/L x 180 minutes (CI, -101 to -21 mmol/L x 180 minutes); decrease in insulin response to oral glucose, 6.2 nmol/L x 180 minutes (CI, -9.8 to -2.6 nmol/L x 180 minutes); decrease in triglyceride level, 0.56 mmol/L (CI, -0.75 to -0.37 mmol/L; P < 0.001); increase in high-density lipoprotein cholesterol level, 0.13 mmol/L (CI, 0.09 to 0.17 mmol/L; P < 0.001); and decrease in lipid peroxidation, 0.25 mumol/L (CI, -0.34 to -0.16 mumol/L).

Conclusions: By improving glucose and lipid metabolism and reducing lipid peroxidation, carvedilol may offer advantages in patients with diabetes and hypertension.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adrenergic alpha-Antagonists / therapeutic use*
  • Adrenergic beta-Antagonists / therapeutic use*
  • Antihypertensive Agents / therapeutic use*
  • Atenolol / therapeutic use*
  • Blood Glucose / metabolism
  • Carbazoles / therapeutic use*
  • Carvedilol
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetic Angiopathies / blood
  • Diabetic Angiopathies / drug therapy*
  • Double-Blind Method
  • Female
  • Humans
  • Hypertension / blood
  • Hypertension / complications
  • Hypertension / drug therapy*
  • Lipid Peroxidation / drug effects
  • Lipids / blood
  • Male
  • Middle Aged
  • Propanolamines / therapeutic use*
  • Single-Blind Method


  • Adrenergic alpha-Antagonists
  • Adrenergic beta-Antagonists
  • Antihypertensive Agents
  • Blood Glucose
  • Carbazoles
  • Lipids
  • Propanolamines
  • Carvedilol
  • Atenolol