Metabolic effects of antihypertensive medications: prognostic role in the development of cardiovascular disease and diabetes mellitus
Abstract
Recently, more and more attention has been paid to metabolic risk factors (RFs), due to their prognostic importance in the development of cardiovascular disease (CVD) and Type 2 diabetes mellitus. The metabolic effects of antihypertensive medications are actively discussed in the literature. It has been demonstrated that ACE inhibitors, calcium antagonists, and I1-imidasoline receptor agonists (IRA) do not affect metabolic RFs, while diuretics (D) and beta-adrenoblockers could worsen the prognosis. In the new European guidelines, alpha-adrenoblockers and IRA are not regarded as first-choice medications, due to the lacking evidence of their effects on end-points. The paper analyses in detail the results of large-scale international trials on D. In particular, the authors discuss the potential of low-dose thiazide D, as a part of combined therapy, in patients with metabolic disturbances and high cardiovascular risk.
About the Authors
M. V. Stroeva
City Clinical Hospital No. 49. Moscow
Russian Federation
Russian Federation
M. N. Mamedov
State Research Centre for Preventive Medicine, Federal Agency on High Medical Technologies
Russian Federation
Russian Federation
References
1. Оганов Р.Г. Концепция факторов риска как основа профилактики сердечно-сосудистых заболеваний. Врач. 2001; 7: 3-6.
2. WHO/FAO. Diet, Nutrition and the Prevention of Chronic Diseases. Technical Report Series no. 916. WHO, Geneva, 2003.
3. Scherer P.E. Adiponectin: its multiple roles. Diabetes UK, Diabetic Medicine 2006; 23(Suppl.4): 43.
4. Homma Y. Predictors of atherosclerosis. J Atheroscler Thromb 2004; 11(5): 265-70.
5. Yusuf S., Hawken S., Ounpuu S. et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART Study): case -control study). Lancet 2004; 364: 937-52.
6. Haffner S.M., Eehto S., Rönnemaa T. et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med1998; 339: 229-34.
7. Bartnik M., Ryden Е., Ferrari R. et al. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart. Eur Heart J 2004; 25(21): 1880-90.
8. DECODE Study Group. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. Lancet 1999; 354: 617-21.
9. Johnson R.J., Kivlighn S.D., Kim Y.G. et al. Reappraisal of the pathogenesis and consequences of hyperuricaemia in hypertension, cardiovascular disease, end renal disease. AM J Kidney Dis 1999; 33: 225-34.
10. Alderman M.H. Serum Uric Acid As a Cardiovascular Risk Factor for Heart Disease. Cur Hyperten Rep 2001; 3:184-9.
11. Goya Wannamethee S. Serum Uric Acid Is Not an Independent Risk Factor for Coronary Heart Disease. Curr Hyperten Rep 2001; 3:190-6.
12. Рабочая группа по лечению артериальной гипертонии Европейского общества гипертонии (ESH) и Европейского общества кардиологов (ESC). Рекомендации 2007 года по лечению артериальной гипертонии. РФК 2008; 2: 93-123.
13. Brown M.J., Palmer C.R., Castaigne A. et al. Morbidity and mortality in patients randomized to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT). Lancet. 2000; 356: 366-72.
14. The ALLHAT Officers and Coordinators Major outcomes in high-risk hypertensive patients randomized to angiotensincon-verting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA 2002; 288: 2981-97.
15. Gress T.W., Nieto F.J., Shahar E. et al. Hypertension and anthihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study. New Engl J Med 2000; 342: 905-12.
16. Oparil S., Weber M. Hypertension: a companion to Brenner and Rector"s The Kidney. Philadelphia: W.B. Saunders Company 2000.
17. HOPE study investigators Effects of an angiotensin-converting-enzime inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342: 145-53.
18. CAPPP. Hansson L., Lindholm L.H., Niskanen L. et al. Effects of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the captopril prevention project (CAPPP) randomized trial. Lancet 1999; 353: 611-6.
19. Дедов И.И., Шестакова М.В. Сахарный диабет и артериальная гипертензия. Из-во МИА. Москва. 2006; 225-6.
20. Sanjuliani A.F., Francischetti E.A., Genelhu de Abreu V. Effects of moxonidine on the sympatheric nervous system, blood pressure, plasma rennin activity, plasma aldosterone, leptin, and metabolic profile in qbese hypertensive patients. J Clin Basic Cardiol 2004; 7: 19-25.
21. Kaan E., Zeigler D., Frohly P. et al. Effect of moxonidine and agmantine on glucose metabolism. Cardiovasc Risk Factors 1996; 5: 331-8.
22. Dahlov B., Devereux R.B., Kjeldsen S.E. et al. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction ih hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002; 359: 995-1003.
23. Julius S., Kjeldsen S.E., Weber M. et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomized trial. Lancet 2004; 363:1198-204.
24. Третий пересмотр рекомендаций ВНОК по профилактике, диагностике и лечению артериальной гипертензии. Национальные клинические рекомендации. Москва. "Силицея-Полиграф". 2008; 20-56.
25. Школа по диагностике и лечению метаболического синдрома. Пособие для врачей. Под редакцией Оганова Р.Г., Мамедова М.Н. Из-во Медицинская книга. Москва. 2007; 49-56.
26. Lindholm L.H., Persson M., Alaupovic P. et al. Metabolic outcome during 1 year in newly detected hypertensives: results of the Antihypertensive Treatment and Lipid Profile in a North of Sweden Efficacy Evalution (ALPINE study). Hypertension 2003; 21: 563-74.
27. Dahlof B., Sever P., Poulter N.R. et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazde as required in the ASCOT-BPLA: a multicenter randomized controlled trial. Lancet 2005; 366: 895-906.
28. Pepine C., Handberg E.M., Cooper-deHoff R.M. et al. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA 2003; 290: 2805-16.
29. Carlberg B., Samuelsson O., Lindholm L.H. Atenolol in hypertension: is it a wise choice? Lancet 2004; 364: 1684-9.
30. Jamerson K.A., on behalf of the ACCOMPLISH investigators. Avoiding cardiovascular events in combination therapy in partients living with systolic hypertension. American College of Cardiology Scientific Sessions; March 31, 2008; Chicago, IL.
31. Collins R., Peto R., MacMahon S. et al. Blood pressure, stroke and coronary heart disease. Part II: Effects of short-term reductions of blood pressure -an overview of the unconfined randomized drug trials in an epidemiological context. Lancet 1990; 335:
32. Небиеридзе Д.В., Оганов Р.Г. Метаболические и сосудистые эффекты антигипертензивной терапии. Из-во Универсум Паблищинг. Москва. 2005; 8-28.
33. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3255-64.
34. Jounela A.J., Lilij M., Lumme J. Relation between low dose of hydrochlorothiazide, antihypertensive effect and adverse effects. Blood Press 1994; 3(4): 231-5.
Review
For citations:
Stroeva M.V., Mamedov M.N. Metabolic effects of antihypertensive medications: prognostic role in the development of cardiovascular disease and diabetes mellitus. Cardiovascular Therapy and Prevention. 2010;9(2):80-85. (In Russ.)
Views:
430
Email this article 
