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Effects of antihypertensives on plasma lipids and lipoprotein metabolism
1Medizinische Kernklinik und Poliklinik, Universitäts-Krankenhaus Eppendorf, Hamburg, West Germany.
Insights
Antihypertensive drugs can alter blood lipid levels, potentially increasing cardiovascular risk. Measuring blood lipids before treatment is crucial for identifying patients who may benefit from alternative therapies.
Area of Science:
- Cardiovascular Pharmacology
- Lipid Metabolism
- Hypertension Management
Background:
- Hypertension is linked to cardiovascular disease risk.
- Blood pressure reduction trials have not consistently shown decreased cardiac events.
- Antihypertensive drugs may negatively impact lipoprotein metabolism, offsetting benefits.
Purpose of the Study:
- To review the effects of various antihypertensive drugs on plasma lipids, lipoproteins, and apolipoproteins.
- To describe mechanisms of drug-induced lipid metabolism changes.
- To discuss clinical significance and implications for treatment initiation.
Main Methods:
- Literature review of studies on antihypertensive drug effects on lipids.
- Analysis of drug classes including diuretics, beta-blockers, calcium antagonists, ACE inhibitors, and alpha-1 inhibitors.
- Description of cellular lipid metabolism pathways involved.
Main Results:
- Thiazide diuretics elevate triglycerides and VLDL, slightly increase total cholesterol and LDL, with minimal HDL impact.
- Nonselective beta-blockers increase triglycerides and VLDL, decrease HDL, with no significant effect on total cholesterol and LDL.
- Cardioselective beta-blockers show similar but less pronounced lipid changes.
- Calcium antagonists and ACE inhibitors have no significant lipid effects.
- Alpha-1 inhibitors decrease triglycerides, total cholesterol, VLDL, and LDL, while increasing HDL.
Conclusions:
- Antihypertensive drugs exhibit varied effects on lipid profiles.
- Mechanisms involve alterations in LDL receptors, lipid synthesis, and enzyme activity.
- Pre-treatment lipid measurement is recommended to identify hyperlipidemia and guide therapy.
Abstract:
There is good epidemiologic evidence that hypertension is associated with a high risk of cardiovascular disease. However, primary intervention trials have failed to demonstrate that a reduction in blood pressure in hypertensive patients reduces morbidity and mortality from cardiac events. Since various antihypertensive drugs adversely affect lipoprotein metabolism, these drugs may increase associated coronary risk and offset the beneficial effects of lowering blood pressure. This article reviews the effects of various antihypertensive drugs on plasma lipids, lipoproteins, and apolipoproteins. They can be summarized as follows: thiazide-type diuretics cause a marked elevation of plasma triglycerides and very low-density lipoprotein (VLDL) and minor increases in total cholesterol and low-density lipoprotein (LDL), but have little effects on high-density lipoprotein (HDL). The nonselective beta-blockers do not significantly affect total cholesterol and LDL, but increase total triglycerides and VLDL and decrease HDL. The changes in plasma lipids and lipoproteins caused by cardioselective beta-blockers and beta-blockers with intrinsic sympathomimetic activity are qualitatively similar but less pronounced. Calcium antagonists and angiotensin-converting enzyme inhibitors appear to have no significant effects on plasma lipids. alpha 1-Inhibitors reduce total triglycerides, total cholesterol, VLDL, and LDL and increase HDL. The possible mechanisms by which antihypertensive drugs affect cellular lipid metabolism (e.g., LDL receptor, lipid synthesis, lipoprotein lipase, lecithin cholesteryl acyltransferase, acylcholesteryl acyltransferase, and cholesteryl ester hydrolase) are described. The clinical significance of changes in blood lipids and cellular lipid metabolism caused by antihypertensive drugs is not yet totally clear. Nevertheless, before antihypertensive drug treatment is initiated, blood lipid levels should be measured to identify preexisting hyperlipidemia.(ABSTRACT TRUNCATED AT 250 WORDS)