Serum cholesterol during treatment of hypertension with diuretic drugs

Twenty-three men had an increase in serum levels of total cholesterol and triglycerides after starting a diet to lower their serum cholesterol. They had simultaneously started therapy with, or increased the dosage of, chlorthalidone or hydrochlorothiazide for the treatment of hypertension. To evaluate a possible role of the diuretics in the increase in serum lipid concentrations, 11 of the men were randomly allocated to spironolactone therapy for two to four months. After receiving spironolactone, cholesterol levels decreased by 24 mg/dL, whereas cholesterol levels decreased by only 3 mg/dL in the 12 men still receiving chlorthalidone (P less than .05). The triglyceride level decreased by 58 mg/dL after the change to spironolactone therapy, whereas it decreased by 10 mg/dL during continued chlorthalidone treatment (P less than .05). When the 11 men again received chlorthalidone, their cholesterol levels increased 16 mg/dL, whereas cholesterol levels decreased by 11 mg/dL in men receiving uninterrupted chlorthalidone treatment (P less than .01). These observations suggest that spironolactone may be a preferable alternative to thiazide-type agents as first-line therapy for hypertension because of the more favorable influence on serum lipid concentrations.