LONG-TERM METABOLIC EFFECTS OF ANTIHYPERTENSIVE DRUGS

In short-term studies (4 to 6 months) we have reported that antihypert ensive treatment with S-adrenergic blockade and thiazide diuretics ind uced insulin resistance, hyperinsulinemia, and a deranged lipid profil e; the ACE inhibitor captopril increased insulin sensitivity without a ffecting serum lipids. In the present study, 65 of the original 149 pa tients with essential hypertension included in the short-term studies were reexamined after treatment for 2 to 3 years. The hyperinsulinemic euglycemic clamp method showed that the significant decrease in insul in sensitivity (p < 0.01) induced by treatment with pindolol, propanol ol, metoprolol, atenolol, or hydrochlorothiazide after 4 to 6 months p ersisted after 2 to 3 years of treatment. Furthermore, the increase in insulin sensitivity reported for captopril after 6 months (p < 0.05) was not significantly altered during long-term treatment. Also, the ra ised levels of very low-density lipoprotein triglycerides (p < 0.01) a nd reduced levels of high-density lipoprotein cholesterol (p < 0.01) i nduced by most of the beta-adrenergic blockade without intrinsic sympa thomimetic activity and hydrochlorothiazide persisted. Captopril, on t he other hand, did not significantly affect the lipids during prolonge d treatment. In conclusion, the magnitude pf the metabolic effects ind uced by antihypertensive treatment during short-term studies was of th e same order after long-term treatment over 2 to 3 years and were not significantly different from the results in the short-term studies.