Influence of combination of captopril and hydrochlorothiazide on plasma lipids, lipoproteins and apolipoproteins in primary hypertension.

The effects of the combination of captopril and hydrochlorothiazide at modest doses of plasma lipids, lipoproteins and apolipoproteins were investigated in 139 patients with mild to moderate primary hypertension. Following an eight week wash-out period and a 4 week period of monotherapy with either captopril or hydrochlorothiazide, the combination of captopril 50 mg and hydrochlorothiazide 25 mg daily was given for 16 weeks. All factors known to affect plasma lipids were held constant throughout the study (i.e. diet, weight, exercise, caffeine, tobacco). There were significant reductions in total and low density lipoprotein-cholesterol (P < 0.01), total cholesterol/high density lipoprotein-cholesterol (P < 0.001) and low density lipoprotein/high density lipoprotein-cholesterol (P < 0.01) ratios. These favourable changes were significant only in patients whose baseline values were above the 90th centile adjusted for age and sex. The combination had a neutral effect on plasma lipids in patients with normal values. The data suggest that the combination of captopril and hydrochlorothiazide at modest doses does not induce deleterious changes in lipid profile and warrant further long-term controlled studies. This antihypertensive regimen may thus represent an advantageous alternative in subjects with a potentially atherogenic lipoprotein profile.