Does abdominal obesity increase the incidence of adverse metabolic effects associated with hydrochlorothiazide and atenolol in hypertensive patients?
Short-term exposure to hydrochlorothiazide and atenolol is associated with significant adverse metabolic effects, including new-onset diabetes, particularly in hypertensive patients with abdominal obesity.
We assessed adverse metabolic effects of atenolol and hydrochlorothiazide among hypertensive patients with and without abdominal obesity using data from a randomized, open-label study of hypertensive patients without evidence of cardiovascular disease or diabetes mellitus. Intervention included randomization to 25 mg of hydrochlorothiazide or 100 mg of atenolol monotherapy followed by their combination. Fasting glucose, insulin, triglycerides, high-density lipoprotein cholesterol, and uric acid levels were measured at baseline and after monotherapy and combination therapy. Outcomes included new occurrence of and predictors for new cases of glucose > or =100 mg/dL (impaired fasting glucose), triglyceride > or =150 mg/dL, high-density lipoprotein or =150 mg/dL increased from 33% at baseline to 46% at the end of study (P<0.01). New-onset diabetes mellitus occurred in 13 patients (6%) with and in 4 patients (2%) without abdominal obesity. Baseline levels of glucose, triglyceride, and high-density lipoprotein predicted adverse outcomes, and predictors for new-onset diabetes mellitus after monotherapy in those with abdominal obesity included hydrochlorothiazide strategy (odds ratio: 46.91 95% CI: 2.55 to 862.40), female sex (odds ratio: 31.37 95% CI: 2.10 to 468.99), and uric acid (odds ratio: 3.19 95% CI: 1.35 to 7.52). Development of adverse metabolic effect, including new-onset diabetes mellitus associated with short-term exposure to hydrochlorothiazide and atenolol was more common in those with abdominal obesity.
Cooper‐DeHoff et al. (Tue,) studied this question.