title: Changes in selected metabolic parameters in patients over 65 receiving hydrochlorothiazide plus amiloride, atenolol or placebo in the MRC elderly trial.
abstract: Treatment of hypertension reduces incidence of stroke, myocardial infarction and heart failure perhaps partly by controlling different metabolic parameters. There is limited information regarding the changes in potassium, sodium, weight, cholesterol and glucose levels in patients using anti-hypertensives. This study aimed to determine changes in potassium, sodium, glucose, cholesterol, weight, urea and urate levels in patients using anti-hypertensives. Furthermore, to describe these changes and differences between the atenolol, hydrochlorothiazide plus amiloride and placebo arms of the Medical Research Council (MRC) elderly randomised controlled trial.
  
  
  
  Patients were randomly allocated to one of the three treatment arms. Measurements were taken at baseline, end of year one and end of year two in 4396 subjects. Linear Mixed Models (LMM) were used to determine the longitudinal profiles of sodium, potassium, weight, cholesterol, glucose, urea and urate. Estimates of changes within groups and difference between groups were obtained.
  
  
  
  Patients randomised to receive hydrochlorothiazide + amiloride experienced a significantly greater mean reduction in potassium, sodium and weight compared to placebo at end of year one - mean differences in change -0.18 mmol/L, (95 % CI: -0.21, -0.15); -1.45 mmol/L, (95 % CI: -1.62, -1.29) and -0.46 kgs (95 % CI: -0.73, -0.20) respectively, and greater increases in cholesterol, urea and urate - mean differences in change 0.16 mmol/L, (95 % CI: 0.10,0.22); 0.77 mmol/L, (95 % CI: 0.68, 0.87) and 53.10 μmol/L, (95 % CI: 49.35, 56.85) respectively. Changes were in the same direction but smaller in the atenololarm except for potassium and weight (increases). No group differences in glucose were found.
  
  
  
  Results were in line with expectation except for lack of change in glucose in the hydrochlorothiazide + amiloride arms.
authors.affiliation: Community Health Department, Kilimanjaro Christian Medical Centre, P. O. Box 3010, Moshi, Tanzania. d_jeremy5@yahoo.com.|Biostatistics, Institute for Population Health, University of Manchester, Manchester, UK. d_jeremy5@yahoo.com.
authors.forename: Damian J
authors.initials: DJ
authors.lastname: Damian
authors.affiliation: Biostatistics, Institute for Population Health, University of Manchester, Manchester, UK.
authors.forename: Roseanne
authors.initials: R
authors.lastname: McNamee
authors.affiliation: Biostatistics, Institute for Population Health, University of Manchester, Manchester, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Carr
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000584:Amiloride / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001262:Atenolol / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D001835:Body Weight; D002784:Cholesterol / Q000097:blood; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000627:therapeutic use*; D006973:Hypertension / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D057194:Intention to Treat Analysis; D016014:Linear Models; D008297:Male; D011188:Potassium / Q000097:blood; D016037:Single-Blind Method; D012964:Sodium / Q000097:blood; D049993:Sodium Chloride Symporter Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D014508:Urea / Q000097:blood; D014527:Uric Acid / Q000097:blood
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D000959:Antihypertensive Agents; D015415:Biomarkers; D001786:Blood Glucose; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D006852:Hydrochlorothiazide; D014527:Uric Acid; D001262:Atenolol; D000584:Amiloride; D014508:Urea; D002784:Cholesterol; D012964:Sodium; D011188:Potassium
keywords: Amiloride; Anti-hypertensive; Atenolol; Hydrochlorothiazide; MRC; Metabolic parameters