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Metabolic effects of antihypertensive therapy with a calcium antagonist
P E Pool1, J M Herron, S Rosenblatt
1North County Cardiology Research Laboratory, Encinitas, California 92024.
Insights
This study found that sustained-release diltiazem does not adversely affect serum lipids or glucose levels in hypertensive patients. These findings are important for managing cardiovascular risk factors during hypertension treatment.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Diuretics and beta-blockers can negatively impact serum glucose and lipid profiles, potentially affecting cardiovascular mortality.
- Calcium antagonists are widely used for hypertension, but their effects on lipids and glucose require further investigation.
- Previous data on calcium antagonists' lipid effects are limited.
Purpose of the Study:
- To evaluate the effects of sustained-release diltiazem on serum lipids and glucose levels.
- To compare these effects against a placebo in a controlled trial.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 96 patients over 8 weeks.
- Diltiazem dosage was titrated from 240 to 360 mg/day, twice daily.
- Serum lipids (cholesterol, HDL, LDL, triglycerides) and glucose were measured at baseline and week 8.
Main Results:
- Diltiazem effectively lowered blood pressure compared to placebo.
- No statistically significant changes in serum lipids or glucose were observed in the diltiazem group or compared to placebo.
- Specific mean values for lipids and glucose remained stable throughout the study.
Conclusions:
- Sustained-release diltiazem demonstrates a favorable long-term safety profile regarding lipid and glucose metabolism.
- Diltiazem can be considered an antihypertensive option without adverse metabolic side effects.
- This study contributes to understanding the metabolic neutrality of certain calcium antagonists.
Abstract:
The effect of diuretics to increase serum glucose, low-density lipoprotein cholesterol and triglycerides, as well as the adverse changes in triglycerides and high-density lipoprotein cholesterol produced by nonselective beta blockers, have been largely ignored in the treatment of hypertension. However, a number of trials have shown that reductions in serum lipids can alter cardiovascular mortality. Calcium antagonists have become major drugs in the treatment of hypertension, and some data suggest that calcium antagonists may increase serum glucose levels. Significantly less data on lipid effects have been published. Lipid and glucose effects were examined in an 8-week antihypertensive study using a sustained-release preparation of diltiazem titrated from 240 to 360 mg/day in a twice-daily regimen in a randomized, double-blind, placebo-controlled parallel trial in 96 patients. Average supine blood pressure at week 8 was 156/98 mm Hg, standing blood pressure with placebo 152/100 mm Hg, and with diltiazem 147/91 and 144/93 mm Hg. There were no statistically significant changes in serum lipids or glucose in the diltiazem or placebo group or between the groups. Mean values (mg/dl) at baseline and week 8 in the diltiazem group were, respectively, for cholesterol 215 and 218, high-density lipoprotein cholesterol 50 and 51, low-density lipoprotein cholesterol 128 and 133, triglycerides 169 and 175, and glucose 113 and 110. Thus, this large and placebo-controlled study shows that diltiazem is among the antihypertensives with no adverse long-term lipid or glucose effects.