Effects of antihypertensive therapy on glucose and lipid metabolism.

Large epidemiological studies demonstrate only moderate reduction in the incidence of coronary artery disease by antihypertensive drug treatment. This is attributed to the prevalence of multiple risk factors in hypertensive patients and to possible adverse metabolic effects of antihypertensive drugs which may counteract their ability to reduce the risk of cardiovascular disease. The choices for pharmacological blood pressure reduction are divided between five classes with similar antihypertensive efficacy but markedly different influence on coronary risk factors. Hence, the clinician has to consider the prevalence of coexisting coronary risk factors, comorbidity as well as the efficacy, side effects, and mechanisms of drug action.