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[Antihypertensive therapy and modification of metabolic risk factors (glucose and lipid metabolism)]
1Kardiologische Abteilung, Medizinische Universitätsklinik Graz.
Insights
Hypertension medications like diuretics and beta-blockers may worsen cholesterol and glucose levels, counteracting their blood pressure benefits. Further trials are needed to assess the clinical impact of these metabolic side effects.
Area of Science:
- Cardiology
- Pharmacology
- Metabolic Syndrome
Context:
- Meta-analysis of interventional trials in mild to moderate hypertension.
- Observed lesser-than-expected reduction in coronary events.
Purpose:
- Investigate metabolic side effects of common antihypertensive drugs.
- Evaluate impact of diuretics and beta-blockers on lipid and carbohydrate metabolism.
Summary:
- Diuretics and beta-blockers negatively affect lipid profiles (cholesterol, triglycerides) and glucose metabolism (insulin sensitivity).
- Calcium antagonists, ACE-inhibitors, and alpha-blockers show neutral or beneficial metabolic effects.
- Clinical significance of these metabolic side effects remains undetermined.
Impact:
- Highlights potential limitations of certain hypertension treatments.
- Suggests need for long-term trials with alternative antihypertensives.
- Informs future drug development and treatment guidelines for hypertension.
Abstract:
Meta-analysis of several large interventional trials in patients with mild to moderate hypertension has shown that coronary events are reduced to a much lesser extent than expected. One of the possible explanations for this are the metabolic side-effects of diuretics and betablockers used in these trials that may counteract their beneficial blood-pressure-lowering effect. Diuretics, especially thiazide, increase total cholesterol (+5%) and LDL-cholesterol (+10%), while betablockers decrease HDL-cholesterol (-5%) and increase triglycerides (+20%). Calcium antagonists and ACE-inhibitors do not affect lipids, and alpha-blockers have some beneficial effects. Regarding the carbohydrate metabolism, diuretics and betablockers decrease insulin sensitivity, increase plasma insulin, LDL-cholesterol, and triglycerides, and reduce HDL-cholesterol. Calcium channel blockers are neutral, while alpha-blockers and ACE-inhibitors improve glucose tolerance and reduce insulin resistance. To date, the clinical relevance of this side-effects is not known. Controlled, long-term trials in hypertensive patients with calcium channel blockers, ACE-inhibitors, and alpha-blockers are needed.