Effects of diuretic drugs on the lipid profile

Thiazide-type diuretic drugs modify the lipoprotein profile when used in the short term treatment of hypertension. Total cholesterol increases by 6 to 7% on average because of raised concentrations of low density or very low density lipoprotein cholesterol or both. High density lipoprotein cholesterol does not change. Spironolactone has a lesser effect on lipids than do thiazides. In contrast, the methylindoline compound, indapamide, a diuretic with vasodilator activity, has produced no adverse effects on lipids or lipoproteins. Long term data on thiazide monotherapy are sparse but suggest a persistence of the lipid effect for as long as 6 years of treatment. The clinical impact of these lipid changes is unclear. Although clinical trials have proved the benefit of lowering cholesterol on the incidence of coronary heart disease, the clinical significance of these diuretic-induced increases is unknown. A clinical trial will be required to resolve the issue by comparing antihypertensive drugs with and without adverse effects on the lipid profile. Because coronary heart disease is the most common complication of mild hypertension, and as diuretic-based regimens have not succeeded in curbing it, resolution of this concern is important.