Long-term effects of antihypertensives on blood lipids.
Considering the long-term effects of the commonly used antihypertensive agents, there appear to be no apparent adverse effects with calcium antagonists and angiotensin converting enzyme (ACE) inhibitors. The literature available concerning the effects of thiazide diuretics and beta-blockers is extensive and rather confusing. In the case of thiazide diuretics, a review of the literature indicates that in the short-term (therapy for less than six months) thiazide diuretics induce a rise in total cholesterol, total triglycerides and low density lipoprotein (LDL) cholesterol, with a possible fall in high density lipoprotein (HDL). If this was translated into long-term effects it could be associated with an increased risk of atherosclerotic disease. However, the long-term effects (therapy for more than six months) are unclear. Several large-scale trials of antihypertensive therapy using diuretics have suggested that the use of diuretics may have reduced the rate of decline of cholesterol levels which would otherwise have occurred. The literature on the effects of beta-blockers on blood lipids and lipoproteins is extensive and conflicting. The most consistent finding is a rise in triglycerides and there is some evidence that this may be due to the inhibition of lipoprotein lipase. Some authors have found an associated fall in total HDL cholesterol. However, analysis of the effects on the main HDL subfractions (HDL2 and HDL3) show an increase in HDL2 and a decrease in HDL3, which may counteract the possibly detrimental reduction in total HDL. Since triglyceride levels have only weak relationship to atherosclerotic risk it seems unlikely that beta-blockers significantly increase this risk.
Ballantyne
D
D
Department of Medical Cardiology, Victoria Infirmary, Glasgow, UK.
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000959:Antihypertensive Agents / Q000494:pharmacology*; D001581:Benzothiadiazines; D004232:Diuretics; D006801:Humans; D008055:Lipids / Q000097:blood*; D049993:Sodium Chloride Symporter Inhibitors / Q000494:pharmacology; D014280:Triglycerides / Q000097:blood
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D004232:Diuretics; D008055:Lipids; D049993:Sodium Chloride Symporter Inhibitors; D014280:Triglycerides