Naunyn-Schmiedeberg's Archives of Pharmacology

, Volume 373, Issue 4, pp 245–258

Metabolic effects of antihypertensive agents: role of sympathoadrenal and renin-angiotensin systems

Editorial

Abstract

Reports of beneficial, neutral and adverse impacts of antihypertensive drug classes on glucose and lipid metabolism can be found in human data. Furthermore, mechanisms for these diverse effects are often speculative and controversial. Clinical trial data on the metabolic effects of antihypertensive agents are highly contradictory. Comparisons of clinical trials involving different agents are complicated by differences in the spectrum of metabolic disturbances that accompany hypertension in different groups of patients. Two physiological systems are predominant at the interface between metabolic and cardiovascular regulation: the sympathetic nervous system (SNS) and the renin-angiotensin system (RAS). These two systems are major targets of antihypertensive drug actions, and also mediate many of the beneficial and adverse effects of antihypertensive agents on glucose and lipid metabolism. Thiazides and β-adrenergic antagonists can adversely affect glucose and lipid metabolism, which are frequently compromised in human essential hypertension, and increase the incidence of new cases of diabetes. Laboratory studies confirm these effects, and suggest that compensatory activation of the SNS and RAS may be one mechanism. Other antihypertensives directly targeting the SNS and RAS may have beneficial effects on glucose and lipid metabolism, and may prevent diabetes. Resolution of the controversies surrounding the metabolic effects of antihypertensive agents can only be resolved by further laboratory studies, in addition to controlled clinical trials.

Keywords

Glucose Insulin resistance Obesity Triglycerides Cholesterol Hypertension Sympathetic nervous system Renin-angiotensin system Angiotensin receptor antagonists 

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© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of NutritionCase Western Reserve University School of MedicineClevelandUSA

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