Holtzman E, Rosenthal T, Goldbourt U, Segal P
Isr J Med Sci. 1984 Dec;20(12):1169-76.
The effects of chlorthalidone and metoprolol on fasting plasma lipids and lipoprotein levels were compared in two similar nonrandomized groups of patients with mild hypertension. Chlorthalidone therapy was associated with an increase in serum cholesterol of 8.1% (17 mg/dl), mainly reflecting an increase in low-density lipoprotein (LDL)-cholesterol. High-density lipoproteins (HDL)-cholesterol decreased, but the difference between pre- and posttreatment levels did not reach statistical significance. Serum triglyceride (TG) concentration increased by 16% (20 mg/dl). Metoprolol therapy was not associated with changes in total, very low-density lipoprotein (VLDL)-, LDL- and HDL-cholesterol levels. Serum TG concentration increased by 22% (28 mg/dl), mainly due to an increase in VLDL-TG. Application of the Israel Ischemic Heart Disease Study data to these findings could predict only a very slight decrease in the 5-year estimated probability of myocardial infarction in the chlorthalidone-treated group. Metoprolol therapy has, theoretically, a more favorable influence on coronary heart disease risk status. These data suggest that the different forms of therapy for mild hypertension have a different effect on the theoretical coronary heart disease risk status, a fact that should be taken into consideration in the choice of medication.
在两组类似的轻度高血压非随机患者中，比较了氯噻酮和美托洛尔对空腹血脂和脂蛋白水平的影响。氯噻酮治疗使血清胆固醇升高8.1%（17mg/dl），主要反映为低密度脂蛋白（LDL）胆固醇升高。高密度脂蛋白（HDL）胆固醇降低，但治疗前后水平差异未达到统计学意义。血清甘油三酯（TG）浓度升高16%（20mg/dl）。美托洛尔治疗与总胆固醇、极低密度脂蛋白（VLDL）、LDL和HDL胆固醇水平的变化无关。血清TG浓度升高22%（28mg/dl），主要是由于VLDL-TG升高。将以色列缺血性心脏病研究数据应用于这些发现，仅能预测氯噻酮治疗组心肌梗死的5年估计概率略有下降。理论上，美托洛尔治疗对冠心病风险状况有更有利的影响。这些数据表明，轻度高血压的不同治疗方式对理论上的冠心病风险状况有不同影响，这一事实在药物选择时应予以考虑。
