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Lipid profile in 100 men with moderate hypertension treated for 1 year with atenolol or hydrochlorothiazide plus
J E Otterstad1, G Froeland, A K Soeyland
1Medical Department, Vestfold Central Hospital, Toensberg, Norway.
Insights
This study found atenolol (A) lowered heart rate and diastolic blood pressure (DBP) more than Moduretic (M). While both treatments did not significantly alter cholesterol or LDL, Moduretic increased HDL and atenolol increased triglycerides.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension management requires careful consideration of drug effects on lipid profiles.
- Beta-blockers and diuretics are common antihypertensive agents with potentially differing metabolic impacts.
Purpose of the Study:
- To compare the 1-year effects of atenolol versus hydrochlorothiazide plus amiloride (Moduretic) on lipid profiles in hypertensive men.
Main Methods:
- A double-blind, randomized study involving 100 hypertensive men.
- Participants received either atenolol or Moduretic, with dose adjustments and add-on therapy (nifedipine) if diastolic blood pressure remained elevated.
- Lipid profiles, including total cholesterol, LDL, HDL, and triglycerides, were monitored over 1 year.
Main Results:
- Atenolol demonstrated a more significant reduction in heart rate and diastolic blood pressure compared to Moduretic.
- No significant differences were observed in total cholesterol, LDL cholesterol, or apoproteins A and B between the groups.
- High-density lipoprotein (HDL) cholesterol increased with Moduretic and decreased with atenolol (p=0.0002).
- Triglycerides increased with atenolol but remained stable with Moduretic (p=0.02).
Conclusions:
- Atenolol and Moduretic have differential effects on HDL cholesterol and triglycerides, despite similar impacts on overall cholesterol and LDL.
- The long-term prognostic significance of these observed differences in HDL and triglycerides warrants further investigation.
Abstract:
A double-blind randomized study comparing the effects of 1 year's treatment with atenolol (A) 50 mg or hydrochlorothiazide 25 mg plus amiloride 5 mg (Moduretic (M)) on the lipid profile was performed in 100 hypertensive men (mean age 47, range 22-64 years). After 4 weeks' wash-out and 4 weeks on placebo therapy subjects were randomized to either A or M therapy and followed up every third month for 1 year. If the diastolic blood pressure (DBP) was greater than or equal to 95 mmHg at a subsequent visit, the doses were doubled (n = 17 for A and n = 12 for M) and, if DBP was still greater than or equal to 95 mmHg on double dose, nifedipine 20 mg b.d. was added (n = 15 for A and n = 27 for M, p less than 0.05). The lowering of heart rate (p = 0.0001) and DBP (p = 0.005) was more pronounced with A after 1 year. During that time no significant treatment differences were noted for total cholesterol, low-density lipoprotein (LDL) cholesterol or apoproteins A and B. High-density lipoprotein (HDL) cholesterol decreased from a mean of 1.19 (+/- 0.36) mmol l-1 to 1.13 (+/- 0.35) with A, and increased from 1.14 (+/- 0.30) mmol l-1 to 1.22 (+/- 0.28) with M, and this treatment difference was significant (p = 0.0002). The triglycerides increased from 2.0 (+/- 1.2) mmol l-1 to 2.3 (+/- 1.6) in the A group and did not change with M treatment (p = 0.02) for treatment difference). In view of similar effects on cholesterol, LDL cholesterol and apoproteins, the prognostic importance of the observed treatment differences on HDL cholesterol and triglycerides remains to be established.