Distinct vascular and metabolic effects of different classes of anti-hypertensive drugs.
BACKGROUND
ASCOT-BPLA study demonstrates that in hypertensive subjects, atenolol+bendroflumethiazide therapy is associated with higher incidence of adverse cardiovascular outcomes and developing diabetes than an amlodipine+perindopril regimen. This is not explained by changes in blood pressure alone. We hypothesized that distinct vascular and metabolic effects of anti-hypertensive drugs may explain these differential effects.


METHODS
Either placebo or one class of anti-hypertensive drug (atenolol 100 mg, amlodipine 10 mg, hydrochlorothiazide 50 mg, ramipril 10 mg, or candesartan 16 mg) was given daily during 8 weeks to 31 patients in each of 6 arms of a randomized, single-blind, placebo-controlled, parallel study.


RESULTS
Atenolol, amlodipine, and candesartan therapies significantly reduced systolic blood pressure when compared with ramipril (P<0.05 by ANOVA). Atenolol and thiazide therapies increased triglycerides levels greater than ramipril or candesartan (P=0.005 by ANOVA). Amlodipine significantly increased HDL cholesterol levels greater than atenolol (P=0.011 by ANOVA). Ramipril and candesartan therapies improved FMD and increased adiponectin levels and insulin sensitivity to a greater extent than atenolol or thiazide therapies (P<0.001 and P<0.015 by ANOVA). Amlodipine therapy increased adiponectin levels greater than atenolol therapy (P<0.05 by ANOVA). Ramipril, candesartan, and amlodipine therapies significantly decreased leptin levels to a greater extent when compared with atenolol or thiazide therapies (P<0.001 by ANOVA). Amlodipine therapies significantly decreased resistin levels greater than ramipril or candesartan therapies (P=0.001 by ANOVA).


CONCLUSIONS
We observed differential effects of anti-hypertensive drugs on endothelial dysfunction and plasma adipocytokines.
Koh
Kwang Kon
KK
Vascular Medicine and Atherosclerosis Unit, Cardiology, Gil Medical Center, Gachon University, Incheon, Republic of Korea. kwangk@gilhospital.com
Quon
Michael J
MJ
Han
Seung Hwan
SH
Lee
Yonghee
Y
Kim
Soo Jin
SJ
Koh
Yesl
Y
Shin
Eak Kyun
EK
D054392:Adipokines / Q000097:blood*; D052242:Adiponectin / Q000097:blood; D000328:Adult; D000368:Aged; D017311:Amlodipine / Q000494:pharmacology / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000145:classification* / Q000494:pharmacology* / Q000627:therapeutic use; D001262:Atenolol / Q000494:pharmacology / Q000627:therapeutic use; D001562:Benzimidazoles / Q000494:pharmacology / Q000627:therapeutic use; D001713:Biphenyl Compounds; D008076:Cholesterol, HDL / Q000097:blood; D015897:Comorbidity; D004730:Endothelium, Vascular / Q000187:drug effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D017257:Ramipril / Q000494:pharmacology / Q000627:therapeutic use; D016037:Single-Blind Method; D013777:Tetrazoles / Q000494:pharmacology / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood
D054392:Adipokines; D052242:Adiponectin; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D008076:Cholesterol, HDL; D013777:Tetrazoles; D014280:Triglycerides; D017311:Amlodipine; D001262:Atenolol; D017257:Ramipril; C081643:candesartan