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Normalization of lipid metabolism after withdrawal from antihypertensive long-term therapy with beta blockers and
M Middeke1, W O Richter, P Schwandt
1Medical Policlinic, University of Munich, FRG.
Insights
Long-term use of hydrochlorothiazide or atenolol for hypertension impacts lipid levels. These unfavorable effects on serum lipoproteins are reversible after stopping these common antihypertensive medications.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Clinical Research
Background:
- Essential hypertension is a common condition requiring long-term management.
- Antihypertensive medications like diuretics and beta-blockers are widely prescribed.
- Previous studies suggest potential adverse effects of these drugs on lipid metabolism.
Purpose of the Study:
- To assess the long-term effects of hydrochlorothiazide and atenolol on blood pressure and serum lipoproteins.
- To determine if lipid changes induced by these antihypertensive drugs are reversible after treatment cessation.
Main Methods:
- A controlled intervention study (HAPPHY) involving 40 men with essential hypertension.
- Patients received either hydrochlorothiazide or atenolol for an extended period (5.2 +/- 1.4 years).
- Blood pressure and serum lipoprotein concentrations were measured during treatment and after a wash-out period.
Main Results:
- Withdrawal of antihypertensive medication led to increased blood pressure in both groups.
- Significant decreases in low-density lipoprotein cholesterol were observed in both diuretic and beta-blocker groups post-washout.
- Total cholesterol decreased in the diuretic group, while high-density lipoprotein cholesterol increased and triglycerides decreased in the beta-blocker group.
Conclusions:
- Long-term treatment with hydrochlorothiazide and atenolol leads to persistent alterations in lipid profiles.
- The unfavorable effects of these antihypertensive drugs on lipid metabolism are reversible after several years of therapy cessation.
- This study provides the first clear evidence of reversibility of lipid changes after long-term use of diuretics and beta-blockers.
Abstract:
Blood pressure and serum lipoprotein concentrations were assessed in 40 men with essential hypertension at the end of a long-term, controlled intervention study (HAPPHY) after 5.2 +/- 1.4 years of treatment with hydrochlorothiazide (n = 23) or atenolol (n = 17) and after a wash-out period. After withdrawal from antihypertensive medication, the blood pressures of patients treated with diuretics or beta blockers rose from 142/93 and 145/91 to 159/106 and 165/104 mm Hg, respectively. At the same time, low density lipoprotein cholesterol decreased by 17 and 12 mg/dl, respectively, in the diuretic and beta blocker groups (p less than 0.05). In addition, total cholesterol decreased by 16 mg/dl (p less than 0.05) in the diuretic group, whereas high density lipoprotein cholesterol increased by 8 mg/dl (p less than 0.01) and triglycerides decreased by 27 mg/dl (p less than 0.05) in the beta blocker group at the end of the wash-out period as compared to the final phase of the HAPPHY study. The data indicate the persistence of lipid changes during long-term treatment with hydrochlorothiazide and atenolol. For the first time, it was clearly demonstrated that the well-known unfavorable effects of diuretics and beta blockers on lipid metabolism are reversible after cessation of long-term therapy of several years' duration.