[Metabolic effects of chlorothiazide and propranolol on essential hypertension--a double-blind, cross-over design clinical trial]
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1Department of Internal Medicine, Tri-Service General Hospital, NationalDefense Medical Center.
Insights
Antihypertensive drugs like chlorothiazide and propranolol lower blood pressure but cause adverse metabolic effects. These effects, including increased uric acid and triglycerides, may offset the cardiovascular benefits of treatment.
Area of Science:
- Cardiology
- Pharmacology
- Metabolic Research
Background:
- Antihypertensive drug therapy reduces hypertension-related complications like stroke and heart failure.
- However, long-term use may lead to adverse metabolic effects that counteract therapeutic benefits.
- The impact on coronary heart disease has shown no significant reduction.
Purpose of the Study:
- To evaluate the blood pressure-lowering effects of chlorothiazide and propranolol monotherapy.
- To assess the adverse metabolic effects associated with these antihypertensive drugs.
Main Methods:
- A double-blind, cross-over clinical trial involving 42 patients (22 males, 20 females, mean age 52).
- Patients received either chlorothiazide or propranolol for 12 weeks, with a 2-week placebo washout period in between.
- Stratified randomization by age and sex was employed after a 2-week run-in period.
Main Results:
- Both chlorothiazide and propranolol significantly reduced systolic and diastolic blood pressure.
- Adverse metabolic effects were observed, including increased serum uric acid and triglyceride levels.
- A decrease in high-density lipoprotein cholesterol (HDL-C) concentration was also noted.
Conclusions:
- Chlorothiazide and propranolol effectively lower blood pressure but are associated with unfavorable metabolic changes.
- These metabolic alterations may counterbalance the cardiovascular benefits of antihypertensive therapy.
- Close monitoring of adverse metabolic effects is crucial during treatment with these medications.
Abstract:
Several studies have shown that antihypertensive drugs therapy could reduce morbidity and mortality of hypertension related complication such as stroke, congestive heart failure and renal failure, but there was no significant reduction of coronary heart disease. The benefit of the treatment on morbidity and mortality may be counterbalanced by adversed metabolic effects of long-term therapy. The purpose of this study is to evaluate the blood pressure-lowering and adverse metabolic effects of chlorothiazide and propranolol monotherapy. A double-blind, cross-over design clinical trial was performed for 42 cases (22 males and 20 females) with the mean age of 52 (from 30 to 59 years old). After 2 weeks run-in period, the patients were assigned to group A and B with age and sex stratification. Chlorothiazide and propranolol were given for 12 weeks in alternative with 2 weeks placebo washout period. Our studies have shown that, chlorothiazide and propranolol could reduce both systolic and diastolic blood pressure significantly. But they also associated with adverse metabolic effects. Serum uric acid and triglyceride increased and decreased the concentration of high density lipoprotein cholesterol (HDL-C). Those changes could counterbalance the benefit of blood pressure-lowering effect of antihypertension. Carefully monitoring the adverse metabolic effects closely is necessary in therapy with these drugs.
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