[Antihypertensive therapy and modification of metabolic risk factors (glucose and lipid metabolism)].
Meta-analysis of several large interventional trials in patients with mild to moderate hypertension has shown that coronary events are reduced to a much lesser extent than expected. One of the possible explanations for this are the metabolic side-effects of diuretics and betablockers used in these trials that may counteract their beneficial blood-pressure-lowering effect. Diuretics, especially thiazide, increase total cholesterol (+5%) and LDL-cholesterol (+10%), while betablockers decrease HDL-cholesterol (-5%) and increase triglycerides (+20%). Calcium antagonists and ACE-inhibitors do not affect lipids, and alpha-blockers have some beneficial effects. Regarding the carbohydrate metabolism, diuretics and betablockers decrease insulin sensitivity, increase plasma insulin, LDL-cholesterol, and triglycerides, and reduce HDL-cholesterol. Calcium channel blockers are neutral, while alpha-blockers and ACE-inhibitors improve glucose tolerance and reduce insulin resistance. To date, the clinical relevance of this side-effects is not known. Controlled, long-term trials in hypertensive patients with calcium channel blockers, ACE-inhibitors, and alpha-blockers are needed.
Kardiologische Abteilung, Medizinische Universitätsklinik Graz.
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Klein
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000097:blood* / Q000517:prevention & control; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy*; D008055:Lipids / Q000097:blood*; D015201:Meta-Analysis as Topic; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D004232:Diuretics; D008055:Lipids; D002784:Cholesterol
Antihypertensive Therapie und Beeinflussung metabolischer Risikofaktoren (Glukose und Fettstoffwechsel).