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Antihypertensive medications and their effects on lipid metabolism

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Abstract

Hypertension and hyperlipidemia are interrelated and share common pathophysiologic mechanisms, such as insulin resistance and endothelial dysfunction. Accumulating evidence shows that it is important to regulate hypertension and hyperlipidemia to reduce cardiovascular risk. However, medications such as β-blockers and thiazide diuretics, which are widely used for blood pressure regulation, are known to have several metabolic side effects. Despite deleterious effects on glucose metabolism and lipid metabolism, these medications have been proven to reduce cardiovascular risk. On the other hand, calcium channel blockers, angiotensin-converting enzyme inhibitors, and α-blockers have either no effect or favorable effects on the lipid profile. This review outlines the need to control hypertension, options for several antihypertensive medications, their differing effects on lipid metabolism, and the clinical implications of their effects on lipid parameters.

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References and Recommended Reading

  1. National Center for Health Statistics: Health, United States, 2007 (with a chart book on the health of Americans). Available at http://CDC.gov/nchs/hus.htm. Accessed February 27, 2008.

  2. Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289:2560–2572.

    Article  PubMed  CAS  Google Scholar 

  3. Vasan RS, Larson MG, Leip EP, et al.: Impact of high normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001, 345:1291–1297.

    Article  PubMed  CAS  Google Scholar 

  4. Perry HM Jr, Davis BR, Price TR, et al.: Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program (SHEP). JAMA 2000, 284:465–471.

    Article  PubMed  Google Scholar 

  5. Staessen JA, Thijs L, Fagard R, et al.: Predicting cardiovascular risk using conventional vs. ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators. JAMA 1999, 282:539–546.

    Article  PubMed  CAS  Google Scholar 

  6. Almgren T, Persson B, Wilhelmsen L, et al.: Stroke and coronary heart disease in treated hypertension: a prospective cohort study over three decades. J Intern Med 2005, 257:496–502.

    Article  PubMed  CAS  Google Scholar 

  7. Andersson OK, Almgren T, Persson B, et al.: Survival in treated hypertension: follow up study after two decades. BMJ 1998, 317:167–171.

    PubMed  CAS  Google Scholar 

  8. Laakso M, Sarlund H, Mykkanen L: Insulin resistance with lipid and lipoprotein abnormalities in subjects with varying degrees of glucose tolerance. Arteriosclerosis 1990, 10:223–231.

    PubMed  CAS  Google Scholar 

  9. Lloyd-Jones DM, Evans JC, Larson MG, et al.: Cross-classification of JNC VI blood pressure stages and risk groups in the Framingham Heart Study. Arch Intern Med 1999, 159:2206–2212.

    Article  PubMed  CAS  Google Scholar 

  10. MacMahon SW, Macdonald GJ, Blacket RB: Plasma lipoprotein levels in treated and untreated hypertensive men and women. The National Heart Foundation of Australia Risk Factor Prevalence Study. Arteriosclerosis 1985, 5:391–396.

    PubMed  CAS  Google Scholar 

  11. Lepira FB, M’Buyamba-Kabangu JR, Kayembe KP, Nseka MN: Correlates of serum lipids and lipoproteins in Congolese patients with arterial hypertension. Cardiovasc J S Afr 2005, 16:249–255.

    PubMed  CAS  Google Scholar 

  12. Lind L, Berne C, Lithell H: Prevalence of insulin resistance in essential hypertension. J Hypertens 1995, 17:1457–1462.

    Google Scholar 

  13. Reaven GM: Role of insulin resistance in human disease. Diabetes 1988, 37:1595–1607.

    Article  PubMed  CAS  Google Scholar 

  14. McFarlane SI, Banerji M, Sowers JR: Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab 2001, 86:713–718.

    Article  PubMed  CAS  Google Scholar 

  15. Sakurai K, Sawamura T: Stress and vascular responses: endothelial dysfunction via lectin-like oxidized low-density lipoprotein receptor-1: close relationships with oxidative stress. J Pharmacol Sci 2003, 91:182–186.

    Article  PubMed  CAS  Google Scholar 

  16. Sawamura T: LOX-1, a lectin-like oxidized LDL receptor identified from endothelial cells, in endothelial dysfunction. Int Congr Ser 2004, 1262:531–534.

    Article  CAS  Google Scholar 

  17. Dandapat A, Hu C, Sun L, Mehta JL: Small concentrations of oxLDL induce capillary tube formation from endothelial cells via LOX-1-dependent redox-sensitive pathway. Arterioscler Thromb Vasc Biol 2007, 27:2435–2442.

    Article  PubMed  CAS  Google Scholar 

  18. Norata GD, Grigore L, Raselli S, et al.: Post-prandial endothelial dysfunction in hypertriglyceridemic subjects: molecular mechanisms and gene expression studies. Atherosclerosis 2007, 193:321–327.

    Article  PubMed  CAS  Google Scholar 

  19. Brook RD: Mechanism of different effects of antihypertensive agents on serum lipids. Curr Hypertens Rep 2000, 2:370–377.

    Article  PubMed  CAS  Google Scholar 

  20. Kasiske BL, Ma JZ, Kalil RS, Louis TA: Effects of antihypertensive therapy on serum lipids. Ann Intern Med 1995, 122:133–141.

    PubMed  CAS  Google Scholar 

  21. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002, 288:2981–2997.

    Article  Google Scholar 

  22. Grimm RH, Flack JM, Grandits GA, et al.: Long-term effects on plasma lipids of diet and drugs to treat hypertension. Treatment of Mild Hypertension Study (TOMHS) Research Group. JAMA 1996, 275:1549–1556.

    Article  PubMed  CAS  Google Scholar 

  23. McMahan CA, Gidding SS, Fayad ZA, et al.: Risk scores predict atherosclerotic lesions in young people. Arch Intern Med 2005, 165:883–890.

    Article  PubMed  Google Scholar 

  24. Appel GB, Radhakrishnan J, Avram MM, et al.: Analysis of metabolic parameters as predictors of risk in the RENAAL study. Diabetes Care 2003, 26:1402–1407.

    Article  PubMed  Google Scholar 

  25. Inoue T, Morooka T, Moroe K, et al.: Effect of telmisartan on cholesterol levels in patients with hypertension—Saga Telmisartan Aggressive Research (STAR). Horm Metab Res 2007, 39:372–376.

    Article  PubMed  CAS  Google Scholar 

  26. Taylor EN, Hu FB, Curhan GC: Antihypertensive medications and the risk of incident type 2 diabetes. Diabetes Care 2006, 29:1065–1070.

    Article  PubMed  CAS  Google Scholar 

  27. Ward KD, Sparrow D, Vokonas PS, et al.: The relationships of abdominal obesity, hyperinsulinemia and saturated fat intake to serum lipids levels: Normal Aging Study. Int J Obes Relat Metab Disord 1994, 18:137–144.

    PubMed  CAS  Google Scholar 

  28. Reaven GM, Lithell H, Landsberg L: Hypertension and associated metabolic abnormalities: the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996, 334:374–381.

    Article  PubMed  CAS  Google Scholar 

  29. Sharma AM, Pischon T, Hardt S, et al.: Hypothesis: beta-adrenergic receptor blockers and weight gain: a systematic analysis. Hypertension 2001, 37:250–254.

    PubMed  CAS  Google Scholar 

  30. Bélanger M, Boulay P: Effect of an aerobic exercise training program on resting metabolic rate in chronically beta-adrenergic blocked hypertensive patients. J Cardiopulm Rehabil 2005, 25:354–360.

    Article  PubMed  Google Scholar 

  31. Jacob S, Henriksen EJ: Metabolic properties of vasodilating beta-blockers: management considerations for hypertensive diabetic patients and patients with the metabolic syndrome. J Clin Hypertens (Greenwich) 2004, 6:690–696.

    Article  CAS  Google Scholar 

  32. Remaley AT: Old drug, new tricks, the unexpected effect of doxazosin on high-density lipoprotein. Circ Res 2007, 101:116–118.

    Article  PubMed  Google Scholar 

  33. Lithell HO: Effect of antihypertensive drugs on insulin, glucose, and lipid metabolism. Diabetes Care 1991, 14:203–209.

    Article  PubMed  CAS  Google Scholar 

  34. Khan N, McAlister FA: Re-examining the efficacy of beta-blockers for the treatment of hypertension: a meta-analysis. CMAJ 2006, 174:1737–1742.

    PubMed  Google Scholar 

  35. Baseline rest electrocardiographic abnormalities, antihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Am J Cardiol 1985, 55:1–15.

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Correspondence to Mrunalini Deshmukh.

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Deshmukh, M., Lee, H.W., McFarlane, S.I. et al. Antihypertensive medications and their effects on lipid metabolism. Curr Diab Rep 8, 214–220 (2008). https://doi.org/10.1007/s11892-008-0037-7

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