Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Differentiation of ß-blocker effects on serum lipids and apolipoproteins in hypertensive patients with normolipidaemic or dyslipidaemic profiles
From the Antihypertension Center, Department of Cardiology, University of Athens, Hippokration General Hospital Athens, Greece
Received 18 February 1992; revised 12 June 1992; .
Correspondence Dr Vyssoulis, 17 Panagiotou Street, Papagou, 156 69 Athens, Greece
Abstract
To evaluate the differential effects of ß-blockers on serum lipids and apolipoproteins in normolipidaemic and dyslipidaemic hypertensives, 330 patients with mild to moderate essential hypertension were studied 1 month after placebo therapy and 6 months after monotherapy with propranolol (n = 53), atenolol (n = 66), metoprolol (n = 58), pindolol (n = 53), or celiprolol (n = 100). Serum total cholesterol, triglycerides, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), and apolipoproteins ( Apo ) A, and B were measured at baseline and study end. A total of 136 (41·2%) patients were considered normolipidaemic (pretreatment LDL-C < 160 mg . dl––1) and 194 (58·8%) were considered dyslipidaemic ( LDL-C > 160 mg . dl–1).
Changes in total cholesterol differed between normolipidaemics and dyslipidaemics with propranolol ( + 13% in normolipidaemics vs –0·5% in dyslipidaemics, P<0·001), atenolol ( + 7% vs –2%, P = 0·01), metoprolol ( + 9% vs –4%, P0·0006), pindolol( +8% vs–9%, P<0·001 ), and celiprolol ( –1% vs – 13%, P = 0·002). HDL-C differed less, with propranolol (–18% vs –13%), atenolol (–6% vs –2%), metoprolol (–2% vs–6%), pindolol ( + 4% vs + 1% ), and celiprolol ( + 9% vs +4%); none of these changes between normolipidaemic and dyslipidaemic patients were statistically significant. LDL-C changes differed the most, with propranolol ( + 35% vs–1%, P<0·0001), atenolol (+15% vs–4%, P = 0·001), metoprolol ( + 12% vs –6%, P = 0·004), pindolol (+12% vs–13%, P<0·0001), and celiprolol ( + 3% vs–16%, P = 0·0001). No overall differences between normolipidaemic and dyslipidaemic patients were observed for triglycerides and Apo A1, while changes in Apo B differed to a degree with propranolol ( + 23% vs +18, P=NS), atenolol (–1% vs +4%, P = NS), metoprolol (+13% vs +1%, P = NS), pindolol ( + 14% vs –7%>, P = 002), and celiprolol (–10% vs –8%, P = NS). Patient age did not influence overall serum lipid changes.
It is concluded that older non-cardioselective ß-blockers, such as propranolol, have significant dyslipidaemic effects, particularly in normolipidaemic hypertensive patients. Cardioselective ß-blockers, such as atenolol and metoprolol and non-selective agents with partial agonist activity such as pindolol, have milder effects. Newer cardioselective ß-blockers with partial agonist activity, such as celiprolol, have favourable lipid effects, particularly in dyslipidaemic hypertensive patients.
Key Words: Atenolol • celiprolol • essential hypertension • metoprolol • pindolol • propranolol • serum lipoproteins • serum lipids
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