Effect of alpha- and beta-blocker therapy on blood lipids: European experience.

Although hypertension is a well-established coronary risk factor, controlled, randomized hypertension drug trials have failed to show a definite preventive effect on the incidence of coronary heart disease. Possible adverse metabolic effects, particularly on blood lipids, of some commonly used antihypertensive drugs have been investigated. During the Oslo Study on the treatment of mild hypertension, which was not specifically designed to study the effect on lipids, a decrease in serum high-density lipoprotein cholesterol and an increase in serum triglycerides was observed with a combination of propranolol and hydrochlorothiazide. Therefore, special trials were designed specifically to study the effect of various antihypertensive drugs on blood lipids. Propranolol reduced serum high-density lipoprotein cholesterol (13 percent) and the cholesterol ratio [high-density lipoprotein cholesterol:(low-density lipoprotein cholesterol plus very low-density lipoprotein cholesterol)] by 15 percent and increased total serum triglycerides by 24 percent. Prazosin significantly (p less than 0.01) reduced total serum cholesterol, (9 percent) low-density lipoprotein cholesterol plus very low-density lipoprotein cholesterol (10 percent), and total triglycerides (16 percent), whereas the cholesterol ratio increased by 7 percent. The reduction in high-density lipoprotein cholesterol with propranolol plus prazosin was less than that with propranolol alone. Pindolol (with a high sympathomimetic activity) did not significantly change total cholesterol, low-density lipoprotein cholesterol plus very low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or total triglycerides. Prazosin plus pindolol reduced serum low-density lipoprotein cholesterol plus very low-density lipoprotein cholesterol. The observed reductions in serum high-density lipoprotein cholesterol and the cholesterol ratio with oxprenolol were 11.5 percent and 13.7 percent, respectively, and with atenolol 16.7 percent and 19.2 percent, respectively, whereas total serum triglycerides were increased by 14.9 percent with oxprenolol and 17.9 percent with atenolol. Data provided by other European groups comparing the effect of antihypertensive treatment on lipid metabolism are also reviewed.