Carvedilol versus cardioselective beta-blockers for the treatment of hypertension in patients with type 2 diabetes mellitus.

Treatment with beta-blockers is recommended to achieve and maintain adequate blood pressure control in patients with hypertension, and these agents have been shown to decrease cardiovascular risk factors in patients with both hypertension and type 2 diabetes mellitus. However, beta-blocker therapy also may worsen glycemic and lipidemic control and may lead to microalbuminuria. A recent study showed a better metabolic profile with carvedilol than with metoprolol in patients with both type 2 diabetes and hypertension in the presence of renin-angiotensin system blockade. This beneficial effect on metabolic components has been proposed as attributable to carvedilol's alpha-blocking effects or antioxidant properties. In this article, the pathophysiology of hypertension and type 2 diabetes and the association between them are reviewed, the pharmacologic properties of carvedilol are discussed, and clinical studies in the literature comparing carvedilol with selective beta-blockers in patients with both type 2 diabetes and hypertension are identified and evaluated. This information should be useful to practitioners when selecting the optimum beta-blocker for treating hypertension in patients with type 2 diabetes.