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Adverse metabolic effects of antihypertensive drugs. Is it clinically relevant at all?


Authors: Ondřej Petrák
Authors place of work: Centrum pro výzkum, diagnostiku a léčbu arteriální hypertenze III. Interní kliniky 1. LF UK A VFN v Praze
Published in the journal: AtheroRev 2016; 1(2): 74-79
Category: Reviews

Summary

Adverse metabolic effects of antihypertensive drugs are mentioned in connection with the therapy using beta-blockers and/or diuretics. Both these main classes of antihypertensive drugs have an irreplaceable role to play in the therapy of arterial hypertension and they demonstrably reduce cardiovascular morbidity and mortality among hypertensive patients. On the other hand, they may induce, or rather precipitate the development of diabetes mellitus and dyslipidemia in predisposed individuals, as opposed to the therapy based on inhibitors of the renin-angiotensin system and/or calcium channel blockers. Differences continue to exist as to whether the adverse metabolic effect is so powerful to impact patients prognosis. Furthermore, each class contains a considerably heterogeneous group of drugs with different properties and their adverse metabolic effects thus cannot be generalized. This article summarizes some of the current findings on the effects of diuretics and beta-blockers on blood glucose and plasma lipid metabolism.

Key words:
adverse metabolic effects – diabetes mellitus – dyslipidemia – antihypertensive therapy – beta-blockers – diuretics


Zdroje

1. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31(7): 1281–1357.

2. Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet 2007; 369(9557): 201–207.

3. Duarte JD, Cooper-DeHoff RM. Mechanisms for blood pressure lowering and metabolic effects of thiazide and thiazide-like diuretics. Expert Rev Cardiovasc Ther 2010; 8(6): 793–802.

4. Agarwal R. Hypertension, hypokalemia, and thiazide-induced diabetes: a 3-way connection. Hypertension 2008; 52(6): 1012–1013.

5. Pickkers P, Schachter M, Hughes AD et al. Thiazide-induced hyperglycaemia: a role for calcium-activated potassium channels? Diabetologia 1996; 39(7): 861–864.

6. Shafi T, Appel LJ, Miller ER et al. Changes in serum potassium mediate thiazide-induced diabetes. Hypertension 2008; 52(6): 1022–1029.

7. Zillich AJ, Garg J, Basu S et al. Thiazide diuretics, potassium, and the development of diabetes: a quantitative review. Hypertension 2006; 48(2): 219–224.

8. Deshmukh M, Lee HW, McFarlane SI et al. Antihypertensive medications and their effects on lipid metabolism. Curr Diab Rep 2008; 8(3): 214–220.

9. Lindholm LH, Persson M, Alaupovic P et al. Metabolic outcome during 1 year in newly detected hypertensives: results of the Antihypertensive Treatment and Lipid Profile in a North of Sweden Efficacy Evaluation (ALPINE study). J Hypertens 2003; 21(8): 1563–1574.

10. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. 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(23): 2981–2997. Erratum in JAMA 2004; 291(18): 2196. JAMA 2003; 289(2): 178.

11. Weidmann P. Metabolic profile of indapamide sustained-release in patients with hypertension: data from three randomised double-blind studies. Drug Saf 2001; 24(15): 1155–1165.

12. Raggi U, Palumbo P, Moro B et al. Indapamide in the treatment of hypertension in non-insulin-dependent diabetes. Hypertension 1985; 7(6 Pt 2): II157-II160.

13. Marre M, Puig JG, Kokot F et al. Equivalence of indapamide SR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: the NESTOR Study. J Hypertens 2004; 22(8): 1613–1622.

14. Bangalore S, Parkar S, Grossman E et al. A meta-analysis of 94,492 patients with hypertension treated with beta blockers to determine the risk of new-onset diabetes mellitus. Am J Cardiol 2007; 100(8): 1254–1262.

15. Gupta AK, Dahlof B, Dobson J et al. Determinants of new-onset diabetes among 19,257 hypertensive patients randomized in the Anglo-Scandinavian Cardiac Outcomes Trial--Blood Pressure Lowering Arm and the relative influence of antihypertensive medication. Diabetes Care 2008; 31(5): 982–988.

16. Verdecchia P, Reboldi G, Angeli F et al. Adverse prognostic significance of new diabetes in treated hypertensive subjects. Hypertension 2004; 43(5): 963–969.

17. Samuelsson O, Hedner T, Berglund G et al. Diabetes mellitus in treated hypertension: incidence, predictive factors and the impact of non-selective beta-blockers and thiazide diuretics during 15 years treatment of middle-aged hypertensive men in the Primary Prevention Trial Goteborg, Sweden. J Hum Hypertens 1994; 8(4): 257–263.

18. Kostis JB, Wilson AC, Freudenberger RS et al. Long-term effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes. Am J Cardiol 2005; 95(1): 29–35.

19. Roush GC, Ernst ME, Kostis JB et al. Head-to-head comparisons of hydrochlorothiazide with indapamide and chlorthalidone: antihypertensive and metabolic effects. Hypertension 2015; 65(5): 1041–1046.

20. Jeunemaitre X, Charru A, Chatellier G et al. Long-term metabolic effects of spironolactone and thiazides combined with potassium-sparing agents for treatment of essential hypertension. Am J Cardiol 1988; 62(16): 1072–1077.

21. Bakris G, Molitch M, Hewkin A et al. Differences in glucose tolerance between fixed-dose antihypertensive drug combinations in people with metabolic syndrome. Diabetes Care 2006; 29(12): 2592–2597.

22. Bakris G, Molitch M, Zhou Q et al. Reversal of diuretic-associated impaired glucose tolerance and new-onset diabetes: results of the STAR-LET study. J Cardiometab Syndr 2008; 3(1): 18–25.

23. Martinez-Martin FJ, Rodriguez-Rosas H, Peiro-Martinez I et al. Olmesartan/amlodipine vs olmesartan/hydrochlorothiazide in hypertensive patients with metabolic syndrome: the OLAS study. J Hum Hypertens 2011; 25 (6): 346–353.

24. Jamerson K, Weber MA, Bakris GL et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008; 359(23): 2417–2428.

25. Toblli JE, DiGennaro F, Giani JF et al. Nebivolol: impact on cardiac and endothelial function and clinical utility. Vasc Health Risk Manag 2012; 8: 151–60.

26. Leonetti G, Egan CG. Use of carvedilol in hypertension: an update. Vasc Health Risk Manag 2012; 8: 307–322.

Štítky
Angiology Diabetology Internal medicine Cardiology General practitioner for adults
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