COMPARISON OF THE HEMODYNAMIC AND METABOLIC EFFECTS OF LOW-DOSE HYDROCHLOROTHIAZIDE AND LISINOPRIL TREATMENT IN OBESE PATIENTS WITH HIGH BLOOD-PRESSURE
Gm. Reaven et al., COMPARISON OF THE HEMODYNAMIC AND METABOLIC EFFECTS OF LOW-DOSE HYDROCHLOROTHIAZIDE AND LISINOPRIL TREATMENT IN OBESE PATIENTS WITH HIGH BLOOD-PRESSURE, American journal of hypertension, 8(5), 1995, pp. 461-466
Patients with high blood pressure tend to be insulin resistant, glucos
e intolerant, hyperinsulinemic, and dyslipidemic. Since these metaboli
c defects are accentuated by obesity, we thought it important to compa
re the effects of 3 months' treatment with either lisinopril (20 mg/da
y) or low dose hydrochlorothiazide (12.5 mg/day) on blood pressure and
glucose, insulin, and lipoprotein metabolism in obese patients with h
ypertension. There were 14 patients in each group, and they were simil
ar (mean +/- SE) in age (54 +/- 3 v 50 +/- 4 years), gender (nine men/
five women), and body mass index (33.4 +/- 0.8 v 33.9 +/- 0.9 kg/m(2))
. Patients treated with lisinopril had a somewhat greater fall in both
systolic (18 +/- 3 v 10 +/- 3 mm Hg) and diastolic (12 +/- 2 v 8 +/-
1 mm Hg) blood pressure, but only the change in systolic pressure was
statistically significant (P < .05). Plasma glucose, insulin, and trig
lyceride concentrations were measured at hourly intervals from 8 AM to
4 PM (breakfast at 8 AM and lunch at 12 PM), and there was a modest i
ncrease in all three variables following hydrochlorothiazide treatment
(P < .05 to P < .09). However, daylong plasma glucose, insulin, and t
riglyceride concentration did not change with lisinopril treatment. Fi
nally, neither the ability of insulin to mediate glucose disposal nor
fasting lipid and lipoprotein concentrations, changed with either trea
tment. In conclusion blood pressure decreased significantly following
treatment with either lisinopril (20 mg/day) or hydrochlorothiazide (1
2.5 mg/day). Both treatments were associated with little or no untowar
d effect on multiple aspects of glucose, insulin, and lipoprotein meta
bolism that increase risk of coronary heart disease, although these me
tabolic variables did increase somewhat in hydrochlorothiazide-treated
patients.