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International Journal of Obesity 35, 1395-1403 (November 2011) | doi:10.1038/ijo.2010.284
Metabolic sequelae of ?-blocker therapy: weighing in on the obesity epidemic?
P Lee, A-P Kengne, J R Greenfield, R O Day, J Chalmers and K K Y Ho
Sympathetic activation is an important metabolic adaptation limiting weight gain. Propensity of weight gain associated with ?-blocker therapy in the obese modern population is unknown.
To determine whether chronic ?-blocker therapy reduces energy expenditure (EE) and increases body weight.
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 ?-blocker and anthropometrically matched controls (n=19) and (ii) three cross-sectional studies comparing body weight, body mass index (BMI) and waist circumference between ?-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).
Among weight-matched ?-blocker users, diet-induced thermogenesis, fat oxidation rate and weekly habitual activity were lower by 50% (P<0.01), 32% (P=0.04) and 30% (P<0.01), respectively, compared with controls. In ?-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 ?-blockers. BMI displayed a similar difference.
EE is reduced and body weight increased in chronic ?-blocker users. We hypothesise that chronic ?-blockade causes obesity by blunting EE.