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  • Title: [Antihypertensive therapy and modification of metabolic risk factors (glucose and lipid metabolism)].
    Author: Klein W.
    Journal: Z Kardiol; 1992 Jun; 81(6):295-302. PubMed ID: 1353932.
    Abstract:
    Meta-analysis of several large interventional trials in patients with mild to moderate hypertension has shown that coronary events are reduced to a much lesser extent than expected. One of the possible explanations for this are the metabolic side-effects of diuretics and betablockers used in these trials that may counteract their beneficial blood-pressure-lowering effect. Diuretics, especially thiazide, increase total cholesterol (+5%) and LDL-cholesterol (+10%), while betablockers decrease HDL-cholesterol (-5%) and increase triglycerides (+20%). Calcium antagonists and ACE-inhibitors do not affect lipids, and alpha-blockers have some beneficial effects. Regarding the carbohydrate metabolism, diuretics and betablockers decrease insulin sensitivity, increase plasma insulin, LDL-cholesterol, and triglycerides, and reduce HDL-cholesterol. Calcium channel blockers are neutral, while alpha-blockers and ACE-inhibitors improve glucose tolerance and reduce insulin resistance. To date, the clinical relevance of this side-effects is not known. Controlled, long-term trials in hypertensive patients with calcium channel blockers, ACE-inhibitors, and alpha-blockers are needed.
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