Antihypertensive drugs and lipids
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
Early trials on the treatment of hypertension based upon high doses of diuretics or beta blockers demonstrated a significant reduction in stroke but a less prominent decline in the incidence of coronary heart disease . This relative lack of coronary benefit may have been related to the adverse effect of these antihypertensive agents on plasma lipids  since even small elevations in serum cholesterol may significantly increase coronary risk, particularly in patients with underlying hypertension . However, when another analysis was published in 2003, which included multiple studies with lower doses of diuretics and newer agents, a greater reduction of coronary heart disease was documented .
Drug-induced changes in lipid levels may be particularly important in hypertensives since up to 40 percent of untreated patients with primary hypertension (formerly called "essential" hypertension) already have lipid abnormalities, such as a high LDL-cholesterol and a low HDL-cholesterol . Obesity, diabetes, or alcohol abuse may be responsible for this association. In addition, genetic studies in humans suggest that a predisposition for the development of both hypertension and dyslipidemia may result from the inheritance of shared genetic risk factors . (See "Prehypertension".)
It is important to appreciate, however, that the potential adverse effect of antihypertensive therapy on lipid metabolism does not mean that such therapy should be withheld. A report from the Helsinki Heart Study, for example, demonstrated that effectively treating hypertension in hypertensive, dyslipidemic men (primarily with diuretics and beta blockers) reduced the risk of coronary events by more than 50 percent when compared to those with persistent hypertension .
Treatment of dyslipidemia with HMG CoA reductase inhibitors (statins) may independently lower blood pressure [8,9]. This was best shown by the UCSD Statin study, which was a randomized placebo-controlled trial that included 973 subjects and examined the effect of either 20 mg of simvastatin, 40 mg of pravastatin or placebo on blood pressure at six months . Both statins modestly reduced systolic and diastolic blood pressure by 2.2 and 2.4, respectively. Given that the beneficial actions of antihypertensive agents and statins are not adversely affected (and may be enhanced) with concurrent use, hypertension and dyslipidemia can be effectively treated by administering both classes of drugs.
EFFECTS OF DIFFERENT ANTIHYPERTENSIVE AGENTS
The effects of the different classes of antihypertensive drugs on plasma lipid levels can be summarized as follows:
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