Serum lipoproteins during antihypertensive therapy with beta blockers and diuretics: A controlled long‐term comparative trial

Abstract

Summary:The influence of hydrochlorothiazide and ;itenolol on serum lipoprotcins was investigated in a randomized. prospective study on 68 men with essential hypertension. Cholesterol, high density lipoprotein (HDL) cholesterol. low density lipoprotein (LDH) cholesterol, triglycerides, and the apolipoproteins A1 and B were followed up to 42 months after starting therapy. Following atcnolol scrum (HDL) cholesterol decreased and serum triglycerides increased significantly (p <0.01) from 6 to 42 months. After hydrochlorothiazide serum triglycerides, LDL cholesterol and total cholesterol all increased significantly (p<O.Ol) from 12 to 42 months. The changes were more pronounced under higher doses with beta blockade, but not with diuretics. Thus, both atenolol and hydrochlurothiazide have adverse but different effects on serum lipoproteins after long-temi administration. Continuing investigation is necessary to determine whether these side effects decrease the benefit of blood pressure reduction in patients with hypertension.

Normalization of lipid metabolism after withdrawal from antihypertensive long-term therapy with beta blockers and diuretics.

“…In addition, after the beta blocker was removed, there was a significant reduction of LDL cholesterol during the wash-out period, whereas we could not detect any increase in LDL cholesterol after beta blocker treatment began. 1 This reduction may have been due to the greater number of observed patients (n=17) at the end of this study compared to the number (n=9) in our previous study. As was shown previously, additional therapy with dihydralazine in some patients in both treatment groups had no significant effect on lipid metabolism.…”

“…As was shown previously, additional therapy with dihydralazine in some patients in both treatment groups had no significant effect on lipid metabolism. 1 The persisting effects of beta blockers and diuretics on lipid metabolism during long-term antihypertensive therapy of more than 5 years' duration could have clinical significance for coronary heart disease. With long-term antihypertensive treatment alone, there has been only a moderate reduction of coronary heart disease.…”

Optimizing cardiovascular risk reduction during antihypertensive therapy.

“…This effect appears to be dose-related and persists for 3-7 years of antihypertensive treatment. 70 ' 71 Although all subjects beginning the latter study were not followed for the entire 3-year period, consistent lipid alterations were seen at 1, 2, and 3 years. Not only have the benzodiathiazide agents been implicated, but also chlorthalidone and loop diuretics such as furosemide, particularly when given at antihypertensive doses.…”

Integrated effects of the vasodilating beta-blocker nebivolol on exercise performance, energy metabolism, cardiovascular and neurohormonal parameters in physically active patients with arterial hypertension

“…8 In contrast, some beta receptor blockers, especially those of the first and second generation, and diuretics, at least if administered at higher dose levels, are characterised by unfavourable effects on the metabolic profile. 34,35 In summary, taking the limitations of an open label trial into account, monotherapy with the vasodilating ␤-1 selective beta-blocker nebivolol appears to be a suitable therapeutic option for physically active patients with mild-to-moderate essential hypertension. The pharmacological profile of nebivolol was characterised by effective blood pressure control at rest and during exercise in the presence of neutrality towards exercise-associated metabolism.…”