Metabolic safety of antihypertensive drugs: myth versus reality.
Treatment of hypertension with the major available antihypertensive classes results in a significant improvement in cardiovascular morbidity and mortality. However, there is controversy about whether specific classes of drug therapy have deleterious or beneficial effects on glucose and lipid metabolism. Myths and misconceptions have thus arisen. Although "old" classes of antihypertensives, such as diuretics and beta-blockers, seem to have deleterious effects on glucose and lipid metabolism, the "newer" agents appear to have either neutral or beneficial profiles. The long-term significance of these metabolic changes is still debated. It is known that insulin resistance plays a major role in the pathogenesis of hypertension and type 2 diabetes mellitus. There is increasing evidence that blocking the renin-angiotensin-aldosterone system by using angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers favorably affects insulin sensitivity and, accordingly, decreases the incidence of new-onset type 2 diabetes mellitus.
Stas
Sameer
S
University of Missouri Medical Center, Department of Internal Medicine, Health Sciences Center, Columbia, MO 652212, USA.
Appesh
Lama
L
Sowers
James
J
D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced* / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced* / Q000517:prevention & control; D006973:Hypertension / Q000188:drug therapy*; D007333:Insulin Resistance / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents