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Lipid Profile and Antihypertensive Drugs Dr. Abdul-Khader A. Abdul-Khader MB ChB , M.Sc. ,
Abstract
Background:
cholesterol , but increase significantly triglyceride (TG) and cardiovascular risk factors that commonly coexist . VLDL – cholesterol and decrease HDL – cholesterol. Objective : To evaluate the effects of ß - blocker Diuretics causes a significant elevation of TG with generally
(Atenolol) , ACE inhibitor (Captopril) calcium Channel
no significant changes in TC , LDL – cholesterol , VLDL – blocker (Nefidipin ) and diuretics on serum lipid profiles . cholesterol and HDL-cholesterol. ACE inhibitor and calcium channel blockers appears to have no significant effect on hypertensive patient treated with these antihypertensive drugs, attending different public health clinics in Basrah Conclusion :It may important to measure blood lipid levels
to identify pre-existing hyperlipidemia before starting the Serum lipid profile were determined enzymaticaly using kits antihypertensive therapy and to select antihypertensive agent that will not influence the lipid profile or interfere with the Result : The study has revealed that ß-blocker do not
significantly affect total cholesterol ( TC ) and LDL- Key words: Hypertension, lipid and lipid profiles,
antihypertensive,drugs
Al- Kindy Col Med J 2009; Vol .5 (1) P:1-4

Introduction
(atenolol) , 43 patients with (nefidipin) and 25 patient with diuretics. Patients on combined of treatment, he objective of treating patients with hypertension diabetes mellitus, hyperlipidaemia, asthma, hepatic or Tis not simply to reduce blood pressure, but rather renal impairment, or received the antihypertensive to prevent the associated morbidity and mortality (1) . drugs for less than one year were excluded from this Hypertension is well established a risk factor for coronary heart disease ( CHD ) , however the treatment Control: Thirty untreated hypertensive individuals
of hypertension has not unequivocally shown a were selected with on the bases of at least two preventive effect on the incidence of CHD , as it has recording of diastolic blood pressure of 90 mm Hg and for cerebrovascular disease (2,3,4) .The failure to show a reduction in CHD morbidity with antihypertensive All patients and controls were attendance of different treatment has raised the possibility that metabolic side public health clinics in Basrah province. effects of the drugs used could negate the benefits of Venous blood was collected into clean tubes after an average fast of 14 hours. Specimens were allowed to Hypertension and certain alteration in serum clot at room temperature, serum then separated and lipoproteins such as a decrease high density lipoprotein stored at – 18 oC until subsequent analysis, which was cholesterol (HDL-C) , an increase in low density performed within 1-4 days of collecting the blood lipoprotein cholesterol (LDL-C), and perhaps also elevated triglycerides ( TG) are complementary Serum concentration of total cholesterol( coronary risk factors (8,9) Several antihypertensive agent TC),triglyceride (TG) and high density lipoprotein have been found to influence serum lipid profile cholesterol (HDL-C) , ( after precipitation with sodium (1,8,9,10,11,12,13) Indeed , a few studies claimed that the phosphotungstat–MgCl2) were determined effects of antihypertensive agents on serum lipid might enzymatically using kits from BioMerieux , France. differ in different patient population (14) All procedure was followed according to instructions of The present study was designed to evaluate the effect manufacture. Quality control sera ( lytrol ) were of the commonly used antihypertensive drugs on blood included in each assay batch for all above analytes . Data were expressed as mean +SD and comparison between the mean was made using the student’s t-test. P value < 0.05 was considered as significant. One hundred forty seven patients with essential reduced significantly serum HDL-C ( P< 0.05 ) and hypertension consented to participate in this study. increased significantly both serum TG and VLDL-C Fifty patients were treated with ß-blocker Al-Kindy Col Med J 2008 Vol.5(1) 1 Original Article



Lipid Profile and…………. Dr. Abdul-Khader
(P < 0.005 and 0.05 respectively ). On the other hand and no significant decrease in serum HDL-C (P> 0.05). ß- blocker causes no significant increase in both TC The lipid profiles obtained for subjects taking ACE inhibitor and calcium channel blocker were not The lipid data for subjects on diuretic treatment that significantly altered as compared with controls serum TG was significantly elevated as compared with controls (P < 0.01). On the other hand diuretic cause no significant increase in serum TC, LDL-C and VLDL-C
(Table-2) shows the mean levels of total serum
In (Table-1) the characteristics ( number , age , sex ,
cholesterol (TC) , triglyceride (TG) , high density weight , systolic and diastolic blood pressure ) for all lipoprotein cholesterol (HDL-C) , low density subjects participated in this prospective study. There lipoprotein cholesterol (LDL-C) ,and very low density were no significant differences between the different lipoprotein cholesterol (VLDL-C). Comparison of the data obtained for different groups as compared with (Table- 1)
Characteristics of Controls and Hypertensive Patients Treated withDifferent
Antihypertensive Drugs
Characteristics
ß – blocker
ACE inhibitor
Diuretic
165.6+11.8 158.1+12.8 150.4+15.4 160+7.3 155+10.5 Diastolic 105.9+6.1 95.2+7.3 90.4+8.7 101.3+13.3 99.7+14.3 (Table- 2)
Mean Fasting TC , TG , HDL-C * , LDL-C and VLDL-CAccording to Drugs Used
ß – blocker
ACE inhibitor
Diuretic
antagonist
211.63+53.91 220.43+43.83 209.89+50.32 216.88+49.85 230.67+48.57 145.78+41.35 185.58+67.31*** 139.98+38.11 152.33+50.19 177.47+58.63** 47.73+12.09 41.34+16.27* 48.33+10.57 46.88+11.98 45.92+11.99 133.75+33.58 141.78+26.94 132.09+33.13 139.12+27.84 149.26+27.55 29.16+8.47 35.33+12.63* 30.47+7.62 28.99+10.04 34.59+9.43 Data are presented as mean + SD Mean + S * P < 0.05 * * P < 0.01 * * * P < 0.005 Al-Kindy Col Med J 2008 Vol.5(1) 2 Original Article

Lipid Profile and…………. Dr. Abdul-Khader
Discussion
significance as compared to the data obtained from the The present study was designed to evaluate the effect labile hypertensive subjects. Several previous reports of ß-blocker , ACE inhibitor , calcium channel blocker concluded that diuretics increases serum TG (1,8,10,23) and diuretic on blood lipids. These drugs affect lipid There was controversial finding about the effects of metabolism on quite different way ( 3 ) . diuretics on serum TC and lipoprotein cholesterol In this study ß–blocker reduce serum HDL-C and fraction. Grimm (10) and hunninghake ( 24 ) found that increase serum TG. Previous reports have a direct diuretics increase TC and LDL-C and slightly reduce attention toward the probable unfavorable effects of ß- HDL-C. krone et al(23) showed that diuretics cause a blocker on lipid metabolism. Tanaka et al (15) found a marked elevation of VLDL-C and minor increases of distinct reduction in HDL-C and an increase of VLDL- TC and LDL-C , but have little effects on HDL-C. C and triglyceride but no significant increase on total Weidmann et al. (8) and Kasiske et al (14) observed that serum TC. Wall-manning (16) showed a 42 % increase diuretics can significantly increase TC , LDL-C and in total TG after a year treatment with metaprolol . VLDL-C , while the HDL-C is often largely Others have reported varying effects of ß-blocker on unchanged. The mechanism underlying the diuretics blood lipids. Weidmann et al (8) stated that several ß- induced disturbances in lipid metabolism are unclear. blockers given as monotherapy induce significant They occurred independently of changes in blood increases in TG and a tendency for decreases in HDL-C. Breglund (17) observed a rise in TG and fall in TC after haemoconentration or alteration in basal and glucose propranolol treatment. Shaw et al (18) comparing the stimulated insulin concentration and glucose tolerance effect of different ß-blocker found a significant rise in From the overall data obtained for patients treated ACE The formation of HDL-C probably results from the inhibitor or calcium channel blocker it seems that catabolism of triglyceride-rich lipoproteins (19,20) neither ACE inhibitor nor calcium channel blocker Metacalfe et al (21) concluded that the inverse altered lipid profiles as compared with controls. This result confirmed the previous observations, which stated correlation between TG (increase) and HDL-C ( that both ACE inhibitor, and calcium channel blocker decrease ) and a fall in intralipid clearance during seems to be largely devoid of undesirable effects on adrenergic blockade, suggest that all these changes serum lipoproteins ( 8 , 10 , 12, 23 , 26 ) might to mediated through inhibition of lipoprotein In conclusion the influence of antihypertensive drugs on lipase activity. The changes in triglyceride additional cardiovascular risk factors should considered concentration can not be related to changes in plasma when selecting medication to reduce blood pressure. insulin or glucose concentration (22) In addition the Nevertheless, before antihypertensive drug treatment is consistent decrease in free fatty acid concentrations initiated , blood lipid levels should be measured to during treatment with ß- blockers argues against an identify preexisting hyperlipidaemia. Patient with increase rate of synthesis of TG (21) Inhibition of elevated lipid levels, ß–blocker and diuretics may make lipoprotein lipase could be achieved through either a the management of lipid disorder more difficult and for direct inhibitory action of adrenergic blocking agents such patient it may be desirable to select alternative themselves or secondary unopposed alpha adrenergic antihypertensive agents that will not influence the lipid profile or interfere with the therapy for hyperlipidaemia. In diuretics treated patient, the main finding in the However long term study may be needed to evaluate present study is a significant increase in serum TG. whether lipoprotein abnormalities offset partly the Despite the increment in serum TC, LDL-C and VLDL- beneficial effect of a lowered blood pressure in ß– blocker and diuretic treated patients with hypertension and this study should be more attentive to differences Al-Kindy Col Med J 2008 Vol.5(1) 3 Original Article

Lipid Profile and…………. Dr. Abdul-Khader
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From the Department of Biochemistry, College of Medicine , University of Basrah
Correspondence Address to: Dr. Abdul-Khader A. Abdul-Khader
Received at : 6th -2-2003 Accepted at: 3rd -6-2004
Al-Kindy Col Med J 2008 Vol.5(1) 4 Original Article

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