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Metabolic sequelae of β-blocker therapy: weighing in on the obesity epidemic?

International Journal of Obesity volume 35, pages 1395–1403 (2011)Cite this article

Subjects

Abstract

Background:

Sympathetic activation is an important metabolic adaptation limiting weight gain. Propensity of weight gain associated with β-blocker therapy in the obese modern population is unknown.

Objective:

To determine whether chronic β-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 β-blocker and anthropometrically matched controls (n=19) and (ii) three cross-sectional studies comparing body weight, body mass index (BMI) and waist circumference between β-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 β-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 β-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 β-blockers. BMI displayed a similar difference.

Conclusions:

EE is reduced and body weight increased in chronic β-blocker users. We hypothesise that chronic β-blockade causes obesity by blunting EE.

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Acknowledgements

We thank Wendy Bryant for the provision of data from Diabetes Clinic, St Vincent's Hospital, Sydney, Australia. We also thank the physicians in the Diabetes and Renal Hypertension Clinics for collection of data.

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Authors and Affiliations

  1. Department of Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia,

    P Lee, J R Greenfield & K K Y Ho

  2. Pituitary Research Unit, Garvan Institute of Medical Research, Sydney, New South Wales, Australia

    P Lee & K K Y Ho

  3. Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia

    P Lee, J R Greenfield, R O Day & K K Y Ho

  4. George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia

    A-P Kengne & J Chalmers

  5. Diabetes Centre, St Vincent's Hospital, Sydney, New South Wales, Australia,

    J R Greenfield

  6. Diabetes and Obesity Programme, Garvan Institute of Medical Research, Sydney, New South Wales, Australia

    J R Greenfield

  7. Department of Clinical Pharmacology, St Vincent's Hospital, Sydney, New South Wales, Australia,

    R O Day

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Correspondence to K K Y Ho.

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Competing interests

Dr John Chalmers has received research grants for the ADVANCE trial from Servier International, administered through the University of Sydney. Dr Paul Lee was funded by an Australian National Health Medical Research Council postgraduate scholarship. Dr Kengne, Dr Greenfield, Dr Day and Dr Ho declare no conflict of interest.

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Lee, P., Kengne, AP., Greenfield, J. et al. Metabolic sequelae of β-blocker therapy: weighing in on the obesity epidemic?. Int J Obes 35, 1395–1403 (2011). https://doi.org/10.1038/ijo.2010.284

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  • DOI: https://doi.org/10.1038/ijo.2010.284

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