THE METABOLIC SYNDROME AND THE EFFECTS OF LONG-TERM LOW-DOSE DIURETICS IN ELDERLY WHITE HYPERTENSIVES

Objectives. To determine changes in the metabolic profile of elderly w hite patients with treated hypertension and the effect of withdrawal o f prolonged thiazide therapy. Design. Fifty-eight patients (mean age 6 6.4 +/- 1.4 years; 12 men, 46 women) treated with antihypertensive age nts (including low-dose thiazides) underwent a standard 75 g oral gluc ose challenge with documentation of serial glucose, fasting insulin an d lipid levels. In a subgroup (N = 14), low-dose thiazides were discon tinued and the investigations were repeated 10 months later. Results. Twenty-four patients had normal glucose tolerance (NG) and 34 had abno rmal glucose tolerance (AG). Of the latter, 9 had unsuspected diabetes mellitus. Total fasting cholesterol and triglyceride concentrations, diastolic blood pressure and recorded duration of hypertension were gr eater in AG than NG subjects. There was no evidence of more severe tar get organ damage (ECG or serum creatinine level) in AG than NG subject s. Following withdrawal of low-dose thiazides from a subgroup (N = 14) ,vith AG, no change in glucose or insulin concentrations occurred. The re was a statistically significant decrease in total cholesterol (P = 0.03), triglyceride (P = 0.001) and LDL cholesterol (P = 0.02) levels; the HDL cholesterol level increased (P = 0.003). Conclusion. Dyslipid aemia was closely related to the use of thiazides, albeit in a low dos e, while the high incidence of abnormal glucose tolerance was related to factors other than thiazide use.