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Do beta-blockers alter lipids and what are the consequences?
E Holtzman1, T Rosenthal, U Goldbourt
1Department of Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Abstract:
The unpredictable effect of antihypertensive therapy on coronary risk resulting from changes in lipid levels is an increasingly recognized problem. Different drugs have been shown to exert varying effects on lipids. This problem is particularly evident in young hypertensive patients who may be candidates for lifelong therapy. The effects of chlorthalidone and metoprolol on fasting plasma lipids and lipoprotein levels were compared in two similar nonrandomized groups of patients with mild hypertension. Chlorthalidone therapy was associated with an increase in serum cholesterol of 8.1% (17 mg/dl), mainly reflecting an increase in low-density lipoprotein (LDL) cholesterol. Serum triglycerides increased by 16% (20 mg/dl) and high-density lipoprotein (HDL) cholesterol levels decreased by 10% (3 mg/dl, not significant). Metoprolol therapy induced no changes in total, low, very low, or high-density lipoprotein. Serum triglyceride concentration increased by 22% (28 mg/dl). Application of the Israel Ischemic Heart Disease Study data to these findings indicates a slight decrease at most in the 5-year estimated probability of myocardial infarction in the chlorthalidone-treated group, whereas a clearly favorable influence on the calculated risk of coronary heart disease was observed for those treated with metoprolol. These data suggest that the different forms of therapy for mild hypertension carry varying degrees of significance in terms of risk of coronary heart disease, which should be considered when choosing medication.
Insights
Antihypertensive drugs impact coronary risk differently. Chlorthalidone increased lipids and slightly lowered heart attack risk, while metoprolol had no lipid changes but favorably reduced coronary heart disease risk.
Area of Science:
- Cardiology
- Pharmacology
- Preventive Medicine
Background:
- Antihypertensive therapy can unpredictably affect coronary risk via lipid level alterations.
- This lipid-altering effect is a growing concern, especially for young hypertensive patients requiring long-term treatment.
- Different antihypertensive medications exhibit varied impacts on lipid profiles.
Purpose of the Study:
- To compare the effects of chlorthalidone and metoprolol on fasting plasma lipids and lipoproteins in patients with mild hypertension.
- To assess the implications of these lipid changes on coronary heart disease (CHD) risk.
Main Methods:
- Two similar nonrandomized groups of mild hypertension patients were treated with either chlorthalidone or metoprolol.
- Fasting plasma lipid and lipoprotein levels were measured before and after treatment.
- The Israel Ischemic Heart Disease Study data were applied to estimate changes in myocardial infarction and CHD risk.
Main Results:
- Chlorthalidone increased total cholesterol (8.1%), LDL cholesterol, and triglycerides (16%), while decreasing HDL cholesterol (10%, not significant).
- Metoprolol did not alter total, LDL, or HDL cholesterol levels but increased triglycerides (22%).
- Chlorthalidone showed a minimal decrease in estimated 5-year myocardial infarction probability, whereas metoprolol demonstrated a favorable influence on calculated CHD risk.
Conclusions:
- Different antihypertensive therapies for mild hypertension carry varying significance for coronary heart disease risk.
- Metoprolol appears to offer a more favorable impact on CHD risk compared to chlorthalidone, considering lipid profile changes.
- Medication choice for mild hypertension should incorporate potential effects on lipid levels and overall cardiovascular risk.