DIFFERENT LONG-TERM METABOLIC EFFECTS OF ENALAPRIL AND ATENOLOL IN PATIENTS WITH MILD HYPERTENSION

The primary objective in this multicentre, double-blind randomised, pa rallel study was to compare the metabolic effects of 12 months of trea tment with an ACE inhibitor (enalapril) with those of a selective beta blocker (atenolol) in patients with mild hypertension. The patients (3 5-69 years of age) were included if they were without antihypertensive drugs and after six months of nonpharmacological treatment had supine DBPs between 90 and 104 mmHg; 220 patients were randomised to enalapr il (20 or 40 mg/day) and 218 to atenolol (50 or 100 mg/day). After 12 months of treatment, atenolol significantly increased the glucose conc entrations at 60, 90 and 120 minutes after an oral intake of 75 g gluc ose (P<0.01), while enalapril did not. Atenolol significantly increase d fasting blood glucose and insulin concentration 120 minutes after gl ucose intake, while enalapril did not. Plasma total cholesterol and tr iglycerides increased significantly in patients having atenolol but no t in those having enalapril. HDL cholesterol decreased significantly i n the atenolol group but not in the enalapril group. The proportions o f patients with clinical adverse experiences were similar in both trea tment groups. These results indicate that enalapril does not influence either glucose tolerance or lipoprotein metabolism while atenolol doe s, These findings are consistent over the 12 month treatment period an d confirm earlier shortterm study results.