Blood pressure responses and metabolic effects of hydrochlorothiazide and atenolol

Abstract

Background: Thiazides and β-blockers cause adverse metabolic effects (AMEs), but whether these effects share predictors with blood pressure (BP) response is unknown. We aimed to determine whether AMEs are correlated with BP response in uncomplicated hypertensives.

Methods: In a multicenter, open-label, parallel-group trial, we enrolled 569 persons, aged 17-65, with random assignment to 9 weeks of daily hydrochlorothiazide (HCTZ) or atenolol monotherapy, followed by 9 weeks of add-on therapy with the alternate agent. Measurements included home BP, averaged over 1 week, weight and fasting levels of serum glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, and uric acid (UA) before and after monotherapy and after add-on therapy.

Results: Increases in UA correlated with reductions in systolic BP (SBP) (r = -0.18; P = 0.003) and diastolic BP (DBP) (r = -0.20; P = 0.001) following HCTZ monotherapy and add-on therapy (r = -0.27 and r = -0.21, respectively; both P < 0.001). After adjustment for age, race, gender, and baseline body mass index (BMI), only the correlation between UA and DBP response became nonsignificant. Reductions in HDL correlated with systolic response following atenolol monotherapy (r = 0.18; P = 0.002) and with systolic and diastolic response following add-on therapy (r = 0.30 and r = 0.24, respectively; both P < 0.0001). These correlations remained significant after covariate adjustment. BP responses were not correlated with changes in glucose, LDL, triglycerides, or weight following either therapy.

Conclusions: BP response correlated with changes in UA following HCTZ therapy and HDL following atenolol therapy. No other significant correlations were observed between BP response and AMEs, suggesting that these effects generally do not share predictors. Patients should be monitored for AMEs, regardless of BP response.

Conflict of interest statement

Disclosure: The authors declared no conflict of interest.

© 2012 American Journal of Hypertension, Ltd.

Figures

Figure 1

Relationship between change in serum uric acid level and change in systolic and diastolic blood pressure (BP) following hydrochlorothiazide (HCTZ) monotherapy (top panels) and HCTZ add-on therapy (bottom panels). r values and corresponding P values represent unadjusted Pearson correlation coefficients; adjusted correlation coefficients and P values are denoted in Table 3. Δ represents change in each parameter, calculated as on-treatment value minus baseline value.

Figure 2

Relationship between change in serum high-density lipoprotein (HDL) and systolic and diastolic blood pressure (BP) following atenolol monotherapy (top panels) and atenolol add-on therapy (bottom panels). r values represent unadjusted Pearson correlation coefficients; adjusted correlation coefficients and P values are denoted in Table 3. Δ represents change in each parameter, calculated as on-treatment value minus baseline value.