THE EFFECTS OF ANTIHYPERTENSIVE COMBINATION THERAPY ON LIPID AND GLUCOSE-METABOLISM - HYDROCHLOROTHIAZIDE PLUS SOTALOL VS HYDROCHLOROTHIAZIDE PLUS CAPTOPRIL

Metabolic side-effects of antihypertensive drugs may increase the risk of coronary heart disease despite an adequate blood pressure reductio n. Since combinations of different antihypertensive drugs are often ne cessary and frequently used, we performed a randomized study comparing the effects of a fixed combination of hydrochlorothiazide and sotalol (group A), or hydrochlorothiazide and captopril (group B) on blood pr essure and on lipid and glucose metabolism in 40 men with essential hy pertension over 1 year. Significant blood pressure reductions (p < 0.0 01) were achieved in both treatment groups: from 160/105 to 128/88 mmH g in group A (mean doses: hydrochlorothiazide 33 and sotalol 197 mg) a nd from 162/106 to 135/89 mmHg in group B (hydrochlorothiazide 33 and captopril 64 mg) after 12 months, respectively. No significant changes in body weight were observed in either treatment group. Triglycerides increased (p < 0.05) in both treatment groups (from 183 to 362 mg/dl in A, and from 160 to 196 mg/dl in B) and HDL cholesterol decreased (p < 0.001 and < 0.05) in both groups (from 45.1 to 35.7 mg/dl in A, and from 49.3 to 46.3 mg/dl in B), whereas LDL cholesterol increased sign ificantly (p < 0.05) only in group A from 153 to 164 mg/dl. No signifi cant changes were observed in total cholesterol nor in lipoprotein(a) concentrations in either treatment group. Fasting plasma glucose and h emoglobin A(1) increased significantly (p < 0.05) only in group A afte r 1 year of treatment (from 91.6 to 98.0 mg/dl, and from 6.3 to 6.9%, respectively). Serum levels of creatinine and potassium decreased, and uric acid increased significantly under either combination. Our data show that the diuretic/beta-blocker combination has adverse effects on lipid and glucose metabolism after long-term therapy. The effects of the diuretic/ACE inhibitor combination on lipid metabolism are less pr onounced and there are no adverse effects on glucose metabolism. Howev er, the ACE inhibitor component could not completely counteract the me tabolic effects of the diuretic. Both combinations have no effects on Lp(a). We conclude that the combination of hydrochlorothiazide with an ACE inhibitor has a better metabolic profile for the treatment of ess ential hypertension than the combination with a beta-blocker.