Comparison of the effects of prazosin versus propranolol on plasma lipoprotein lipids in patients receiving hemodialysis.

A prospective, crossover study was used to evaluate the effects of prazosin and propranolol on lipid metabolism in 10 hypertensive patients receiving long-term hemodialysis therapy. Adequate blood pressure control was achieved with either agent (mean predialysis blood pressure was 144/77 mm Hg). Total triglyceride levels increased by 27 +/- 4 percent during propranolol therapy but decreased during prazosin therapy by 8 +/- 2 percent (p less than 0.05). These changes were accounted for by a 21 +/- 1.5 percent increase in very-low-density lipoprotein triglyceride during propranolol therapy and a 6 +/- 2 percent decrease in very-low-density lipoprotein triglyceride during prazosin therapy (p less than 0.05). Although no change in total cholesterol occurred with either agent, a significant decrease (19 +/- 1 percent, p less than 0.01) in high-density lipoprotein cholesterol occurred with propranolol therapy and an increase of 16 +/- 4 percent occurred during treatment with prazosin (not significant). The high-density lipoprotein2 cholesterol levels decreased by 22 +/- 4 percent after treatment with propranolol and increased by 4 percent after prazosin therapy. Propranolol reduced high-density lipoprotein3 cholesterol levels by 18 +/- 2 percent, whereas prazosin increased these values by 19 +/- 2 percent (p less than 0.01). These changes were associated with a reduction in tissue lipoprotein lipase activity after propranolol therapy (2.4 +/- 0.3 percent) and an increase after prazosin therapy (2.5 +/- 1 percent, p less than 0.05). These data suggest that treatment with propranolol may be associated with unfavorable changes in the lipid profile that are not observed after treatment with prazosin.