[Interference with lipid metabolism by various antihypertensive agents: facts and hypotheses]

In view of their effectiveness and safety, beta-blockers and diuretics have become first-line drugs in the treatment of arterial hypertension. Several studies performed over the last few years have elicited undesirable effects of these drugs on plasma lipids and lipoproteins. These changes probably have the same significance as regards the arterial risk as primary or secondary alterations of lipoproteins. In contrast, vasodilators acting by alpha-blockade probably have a favourable effect on lipid metabolism. It therefore seems reasonable, whenever these drugs are prescribed, to carry out regular evaluations of plasma lipids, notably in young subjects to identify those who partly lose the benefit of this treatment owing to a significant degradation of their blood lipid profile. Future epidemiological studies and therapeutic trials should show whether this attitude is right or wrong, their primary objective being to answer the question: do some anti-hypertensive drugs increase, in some subjects, the coronary risk?