Zusammenfassung
Nahezu alle Typ-2-Diabetiker leiden an einer arteriellen Hypertonie, die in der Regel
noch vor dem Diabetes manifest wird. Die konsequente Einstellung der arteriellen Hypertonie
erfordert häufig eine Zweifachkombination aus Angiotensin Converting Enzyme(ACE)-Hemmer
und β-Rezeptorenblocker. Metoprolol ist der häufigste verwendete β-Blocker. Klinische
Studien weisen auf eine Überlegenheit von Carvedilol bezüglich der Qualität der Stoffwechseleinstellung
und der Vermeidung von Folgestörungen des Diabetes hin. Daher scheint Carvedilol der
β-Rezeptorenblocker der Wahl für Patienten mit hohem kardiovaskulären Risiko und insbesondere
Typ-2-Diabetiker zu sein. Wegen fehlender Vergleiche zu Metoprolol-Succinat sowie
zu optimal dosiertem Metoprolol-Tartrat kann aber nicht von einer sicheren Überlegenheit
von Carvedilol ausgegangen werden.
Summary
Nearly all type 2 diabetic patients are suffering from arterial hypertension. The
latter usually becomes manifest earlier than the diabetic metabolic disturbances.
Adequate treatment often requires a combination of angiotensin converting enzyme(ACE)-inhibitors
and β-adrenoceptor antagonists. Metoprolol is still the most frequently used β-adrenoceptor
antagonist in this setting. Some clinical trials have shown carvedilol to be superior
in improving the metabolic situation and prevention of secondary disorders caused
by diabetes. Therefore carvedilol may be the β-adrenoceptor antagonist of choice for
treatment of patients at high cardiovascular risk and especially for diabetes type
2. As comparisons to metoprolol succinate as well as to optimally dosed metoprolol
tartrate are missing, a definite superiority of carvedilol cannot be assumed.
Schlüsselwörter
Diabetes - arterielle Hypertonie - β-Blocker - Metoprolol - Carvedilol
Key words
diabetes - arterial hypertension - β-adrenoceptor antagonists - metoprolol - carvedilol
Literatur
1
Baghestanian M.
Stellenwert der Betablocker in der antihypertensiven Therapie von PAVK-Patienten.
Zeitschrift für Gefäßmedizin.
2006;
3
11-16
2
Bakris G L, Fonseca V, Katholi R E. et al .
Differential effects of beta-blockers on albuminuria in patients with type 2 diabetes.
Hypertension.
2005;
46
1309-1315
3
Bakris G L, Fonseca V, Katholi R E. et al .
Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus
and hypertension: a randomized controlled trial.
JAMA.
2004;
292
2227-2236
4
Bell D S.
Advantages of a third-generation beta-blocker in patients with diabetes mellitus.
Am J Cardiol.
2004;
93
49B-52B
5
Cheng J, Kamiya K, Kodama I.
Carvedilol: molecular and cellular basis for its multifaceted therapeutic potential.
Cardiovasc Drug Rev.
2001;
19
152-171
6
Giugliano D, Acampora R, Marfella R. et al .
Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent
diabetes mellitus and hypertension. A randomized, controlled trial.
Ann Intern Med.
1997;
126
955-959
7
Kindermann M, Maack C, Schaller S. et al .
Carvedilol but not metoprolol reduces beta-adrenergic responsiveness after complete
elimination from plasma in vivo.
Circulation.
2004;
109
3182-3190
8
Kurtz T W, Pravenec M.
Antidiabetic mechanisms of angiotensin-converting enzyme inhibitors and angiotensin
II receptor antagonists: beyond the renin-angiotensin system.
J Hypertens.
2004;
22
2253-2261
9
Kveiborg B, Christiansen B, Major-Petersen A, Torp-Pedersen C.
Metabolic effects of beta-adrenoceptor antagonists with special emphasis on carvedilol.
Am J Cardiovasc Drugs.
2006;
6
209-217
10
McBride, White C M.
Critical differences among beta-adrenoreceptor antagonists in myocardial failure:
debating the MERIT of COMET.
J Clin Pharmacol.
2005;
45
6-24
11
McTavish D, Campoli-Richards D, Sorkin E M.
Carvedilol. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic
efficacy.
Drugs.
1993;
45
232-258
12
Morgan T.
Clinical pharmacokinetics and pharmacodynamics of carvedilol.
Clin Pharmacokinet.
1994;
26
335-346
13
Poole-Wilson P A, Swedberg K, Cleland J G. et al .
Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic
heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled
trial.
Lancet.
2003;
362
7-13
14
Segura J, Ruilope L M.
Antihypertensive therapy in patients with metabolic syndrome.
Curr Opin Nephrol Hypertens.
2006;
15
493-497
15
Stahl E, Henke D, Mutschler E, Spahn-Langguth H.
Saturable enantioselective first-pass effect for carvedilol after high oral racemate
doses in rats.
Arch Pharm (Weinheim).
1993;
326
123-125
16
Stoschitzky K, Koshucharova G, Lercher P. et al .
Stereoselective effects of (R)- and (S)-carvedilol in humans.
Chirality.
2001;
13
342-346
17
Stoschitzky K, Koshucharova G, Zweiker R. et al .
Differing beta-blocking effects of carvedilol and metoprolol.
Eur J Heart Fail.
2001;
3
343-349
Prof. Dr. med. habil. Hagen Sandholzer
Selbstständige Abteilung für Allgemeinmedizin der Universität Leipzig
Philip Rosenthal-Straße 51
04103 Leipzig
Phone: +49 341 9715710
Fax: +49 341 9715719
Email: sanh@medizin.uni-leipzig.de