EFFECTS OF ANTIHYPERTENSIVE THERAPY ON SERUM-LIPIDS

Purpose: To compare and contrast the effects of antihypertensive agent s on serum lipids and blood pressure in different patient populations. Data Sources: A MEDLINE search and bibliographies from recent compreh ensive reviews were used to identify trials that provided sufficient d ata to calculate the change in one or more serum lipid values measured before and after antihypertensive therapy. Study Selection: 474 contr olled and uncontrolled clinical trials investigated the effects of 85 antihypertensive agents on lipids and blood pressure in more than 65 0 00 patients. Data Extraction: Data on triglyceride and total, low-dens ity lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol levels; blood pressure; patient characteristics; and study design. Dat a Synthesis: Differences in the effects of agents, adjusted for differ ences in patient populations and study design, were examined using mul tiple linear regression analysis that was weighted by study quality an d inverse variance. Diuretics caused relative increases in cholesterol levels (regression coefficient = 0.13 mmol/L; 95% CI, 0.09 to 0.18 mm ol/L) that were greater with higher doses (additional effect of high d ose, 0.12 mmol/L; CI, 0.04 to 0.20 mmol/L) and were worse in blacks th an in nonblacks (additional effect in blacks, 0.13 mmol/L; CI, 0.01 to 0.26 mmol/L). beta-blockers caused increases in triglyceride levels ( 0.35 mmol/L; CI, 0.31 to 0.39 mmol/L) that were substantially smaller for agents with intrinsic sympathomimetic activity (amelioration of be ta-blocker increase, -0.21 mmol/L; CI, -0.27 to -0.16 mmol/L). When co mbined with cardioselectivity, beta-blockers with intrinsic sympathomi metic activity favorably affected lipids and reduced both total (-0.14 mmol/L; CI, -0.24 to -0.04 mmol/L) and LDL cholesterol revels (-0.17 mmol/L; CI, -0.28 to -0.07 mmol/L). alpha-Blockers beneficially affect ed total cholesterol (-0.23 mmol/L; CI, -0.28 to -0.18 mmol/L), LDL ch olesterol (-0.20 mmol/L; CI, -0.25 to -0.15 mmol/L), triglycerides (-0 .07 mmol/L; CI, -0.11 to -0.03 mmol/L), and, in younger persons, HDL c holesterol (0.02 mmol/L; 0.01 to 0.04 mmol/L). Converting enzyme inhib itors reduced triglycerides (-0.07 mmol/L; CI, -0.12 to -0.02 mmol/L), and, in patients with diabetes, total cholesterol (-0.22 mmol/L; CI, -0.34 to -0.10 mmol/L). Vasodilators reduced total (-0.22 mmol/l; CI, -0.30 to -0.10 mmol/L) and LDL cholesterol (-0.22 mmol/L; CI, -0.29 to -0.11 mmol/L) and increased HDL cholesterol (0.06 mmol/L; CI, 0.02 to 0.09 mmol/L). Conclusion: With the exception of calcium antagonists, nearly all antihypertensive agents affect serum lipids. These effects differ among patient populations.