Mechanism of differential effects of antihypertensive agents on serum lipids.
Essential hypertension is frequently associated with the metabolic abnormalities of insulin resistance and dyslipidemia. This prevalent clustering of multiple cardiovascular risk factors may help explain the less-than-expected improvement in coronary heart disease mortality provided by simple blood pressure reduction alone. Many antihypertensive medications effectively reduce blood pressure while providing no benefit or even causing a detrimental effect on the associated metabolic abnormalities. beta-Blockers and diuretics tend to negatively affect both glucose tolerance and plasma lipids. Calcium channel blockers, angiotensin converting enzyme inhibitors, and angiotensin II receptor blockers are most often found to be metabolically neutral. alpha-Blockers provide the most favorable metabolic effects of antihypertensive agents by improving both insulin sensitivity and dyslipidemia. The multiple physiologic mechanisms by which blood pressure medications alter plasma lipids are discussed in detail. The effects of antihypertensive medications on postprandial lipid metabolism and the associated postprandial lipemia-induced endothelial dysfunction deserve special attention.
Brook
R D
RD
Division of Hypertension, 3918 Taubman Center, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48104, USA. robdbrok@groupwise.umich.edu.
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000959:Antihypertensive Agents / Q000494:pharmacology*; D001341:Autonomic Nervous System / Q000187:drug effects; D001581:Benzothiadiazines; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics; D006801:Humans; D007328:Insulin / Q000378:metabolism; D008055:Lipids / Q000097:blood*; D008074:Lipoproteins / Q000097:blood; D008833:Microcirculation / Q000187:drug effects; D019518:Postprandial Period; D049993:Sodium Chloride Symporter Inhibitors / Q000494:pharmacology
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D002121:Calcium Channel Blockers; D004232:Diuretics; D007328:Insulin; D008055:Lipids; D008074:Lipoproteins; D049993:Sodium Chloride Symporter Inhibitors