02213nas a2200193   4500000000100000008004100001100001100042700001800053700001100071700001000082700001700092700001600109245008500125250001500210300001300225490000700238520172800245020004601973       2011                            d1 aLee P.1 aGreenfield J.1 aDay R.1 aHo K.1 aKengne Andre1 aChalmers J.00aMetabolic sequelae of beta-blocker therapy: weighing in on the obesity epidemic?  a2011/02/10  a1395-4030 v353 a<p>
BACKGROUND: Sympathetic activation is an important metabolic adaptation limiting weight gain. Propensity of weight gain associated with beta-blocker therapy in the obese modern population is unknown. OBJECTIVE: To determine whether chronic beta-blocker therapy reduces energy expenditure (EE) and increases body weight. METHODS: We undertook (i) a mechanistic study comparing EE, diet-induced thermogenesis and habitual activity between healthy volunteers (n=11) with uncomplicated hypertension treated with a beta-blocker and anthropometrically matched controls (n=19) and (ii) three cross-sectional studies comparing body weight, body mass index (BMI) and waist circumference between beta-blocker treated and untreated patients from ambulatory patients attending (a) diabetes outpatient clinic (n=214), (b) hypertension outpatient (n=84) and (c) participants in a multi-centre type 2 diabetes trial (ADVANCE) (n=11140). RESULTS: Among weight-matched beta-blocker users, diet-induced thermogenesis, fat oxidation rate and weekly habitual activity were lower by 50% (P&lt;0.01), 32% (P=0.04) and 30% (P&lt;0.01), respectively, compared with controls. In beta-blocker treated patients, the adjusted mean body weight was 9.2 +/- 1.2 kg (P=0.0002) higher among those attending the diabetes clinic, 17.2 +/- 3.2 kg (P=0.004) higher among those attending the hypertension clinic and 5.2 +/- 0.7 kg (P=0.0003) higher at baseline among participants in the ADVANCE trial compared with patients not treated with beta-blockers. BMI displayed a similar difference. CONCLUSIONS: EE is reduced and body weight increased in chronic beta-blocker users. We hypothesise that chronic beta-blockade causes obesity by blunting EE.
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