METABOLIC EFFECTS OF VARIOUS ANTIHYPERTENSIVE DRUG COMBINATIONS

Abstract

Aim. To investigate the effects of various antihypertensive combinations on metabolic parameters in patients with arterial hypertension (AH). Material and methods. The study included 144 AH patients and 7 groups of combination therapy: Group 1 (n=30) – trandolapril/verapamil SR; Group 2 (n=19) – perindopril/indapamide; Group 3 (n=15) – felodipine/metoprolol; Group 4 (n=20) – amlodipine/atenolol; Group 5 (n=20) – ACE inhibitor/hydrochlorothiazide (HCT); Group 6 (n=22) – telmisartan/lacidipine; and Group 7 (n=18) – metoprolol/HCT. In all participants, the parameters of lipid, carbohydrate, and purine metabolism were assessed. The effects of antihypertensive combinations on the risk of metabolic disturbances were studied using the factor regression analysis of quantitative and qualitative parameters (factors) as weighted ordered functions. Results. The negative effects on the levels of cholesterol (CH), triglycerides (TG), and glucose were most pronounced for the combination of metoprolol and HCT, while the combination of amlodipine and atenolol demonstrated the weakest negative effects on CH and glucose levels. The levels of CH, TG, and uric acid were affected to the least extent by the combination therapy with ACE inhibitor and HCT, which was also associated with a reduction in glucose levels. The combination of trandolapril and verapamil SR had the largest positive effect on the levels of CH, TG, and uric acid, together with a beneficial effect on glucose levels. The combination therapy with perindopril and indapamide was the most beneficial for the levels of CH and TG, while the felodipine/metoprolol combination had the most pronounced positive effects on TC and glucose levels. The combination of lacidipine and telmisartan was the most beneficial for glucose levels, but negatively affected the levels of uric acid. The perindopril/indapamide combination demonstrated negative effects on glucose levels. The full doses of diuretics and β-blockers negatively affected the levels of TC and glucose, while the full doses of ACE inhibitors benefited these metabolic parameters. Conclusion. The combination of a β-blocker and HCT was the least desirable, in terms of metabolic safety, for the treatment of AH patients. Including ACE inhibitors in the combination therapy demonstrated beneficial metabolic effects. To minimise the pre-existing metabolic disturbances and prevent the negative metabolic effects of diuretics, full doses of ACE inhibitors are required.

Keywords

• arterial hypertension
• combination therapy
• metabolic effects