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Concomitant considerations in long-term antihypertensive treatment
1Medizinische Poliklinik, University of Munich, Germany.
Insights
Long-term use of hydrochlorothiazide and atenolol in hypertensive patients caused persistent adverse lipid metabolism effects. These negative impacts on cholesterol and triglycerides were reversible upon medication discontinuation.
Area of Science:
- Cardiology
- Pharmacology
- Metabolic Medicine
Background:
- Hypertensive patients on medication still face higher risks for coronary events than normotensive individuals.
- The long-term metabolic effects of antihypertensive drugs on lipid profiles remain a concern.
- Understanding these effects is crucial for explaining partial therapeutic failure in hypertension management.
Purpose of the Study:
- To investigate the long-term metabolic effects of antihypertensive therapy on lipid metabolism.
- To assess the reversibility of these metabolic changes after discontinuing medication.
- To evaluate the impact of hydrochlorothiazide and atenolol on cholesterol and triglyceride levels over time.
Main Methods:
- Observational study of hypertensive patients undergoing long-term randomized antihypertensive treatment.
- Analysis of lipid metabolism parameters (total cholesterol, LDL-C, HDL-C, triglycerides) during and after treatment.
- Comparison of lipid levels before, during, and after cessation of hydrochlorothiazide and atenolol therapy.
Main Results:
- Hydrochlorothiazide increased total cholesterol, LDL-C, and triglycerides during treatment.
- Atenolol increased LDL-C and triglycerides while decreasing HDL-C during treatment.
- Discontinuation of both drugs led to significant improvements in lipid profiles, with effects persisting for over five years.
- Adverse metabolic alterations were reversible after medication cessation.
Conclusions:
- Long-term use of hydrochlorothiazide and atenolol is associated with persistent adverse effects on lipid metabolism.
- These metabolic disturbances are reversible upon discontinuation of the antihypertensive agents.
- Minimizing antihypertensive drug dosage may help mitigate adverse metabolic alterations and side effects.
Abstract:
Even with antihypertensive therapy, the risks in hypertensive patients, especially the incidence of coronary events, cannot be lowered to that of the normotensive population. Therefore, the metabolic effects of long-term therapy on lipid metabolism and the efficacy of antihypertensive drugs to lower blood pressure were studied as possible explanations for this partial therapeutic failure. Hypertensive patients who participated in a long-term trial provided a unique opportunity to observe the effects of long-term treatment and of then discontinuing antihypertensive therapy. During treatment, increases in total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides following hydrochlorothiazide, and increases of LDL-C and triglycerides and a decrease of high-density lipoprotein cholesterol (HDL-C) following atenolol were observed up to 42 months. After 5.2 +/- 1.4 years of randomised antihypertensive treatment, cessation of hydrochlorothiazide led to a decrease of total cholesterol from 6.40 to 5.98 mmol/l and of LDL-C from 4.33 to 3.89 mmol/l. After discontinuation of atenolol, LDL-C decreased from 4.20 to 3.89 mmol/l and triglycerides from 2.21 to 1.91 mmol/l, whereas HDL-C increased from 0.96 to 1.17 mmol/l (all differences significant). Thus the adverse effects of both agents persisted for more than five years and were reversible after medication was discontinued. In recent years titration to the lowest possible dose of antihypertensive agents has been suggested to avoid adverse metabolic alterations and subjective side effects.(ABSTRACT TRUNCATED AT 250 WORDS)