Reactions 609 - 13 Jul 1996

Metabolic consequences ofantihypertensive therapy

Adverse metabolic effects have been associated withantihypertensive drugs, especially diuretics and β-blockers. The fact that newer classes of drugs such as α-blockers, calcium antagonists and ACE inhibitors havefew metabolic adverse effects has important clinicalimplications for antihypertensive therapy, in the opinionof Drs Harry Preuss and James Burris from the US.

There is concern that the metabolic effects of thiazidediuretics and β-blockers in particular may adverselyinfluence long-term cardiac risk and thus offset some ofthe benefit attributable to their antihypertensive effects.However, there is still no definitive proof of the clinicalconsequences of these metabolic effects.

Newer drug classes have better metabolicprofiles

Diuretics can cause electrolyte disturbances(hypokalaemia and hypomagnesaemia) and metabolicdisturbances such as increases in circulating plasmacholesterol levels, hyperuricaemia and abnormalglucose/insulin metabolism. Many β-blockers alsoadversely influence glucose/insulin and lipidmetabolism.

In contrast, α-blockers tend to benefit the lipid profilewhile affecting neither glucose/insulin metabolism norelectrolytes. Calcium antagonists are metabolicallyneutral; ACE inhibitors are lipid neutral and may evenfavourably influence glucose/insulin metabolism.

Implications for treatmentIn order to overcome many of the adverse effects of

diuretics, Drs Preuss and Burris suggest that a lowerdosage or a different diuretic may be used. However,not all agree that use of low doses of diuretics can avoidthe deleterious effect of such agents on coronary arterydisease risk. Drs Preuss and Burris say that indapamidemay accomplish many of the beneficial effects ofthiazides without causing many of the adverse effects.Preuss HG, et al. Adverse metabolic effects of antihypertensive drugs: implicationsfor treatment. Drug Safety 14: 355-364, Jun 1996 800450060

1

Reactions 13 Jul 1996 No. 6090114-9954/10/0609-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved