Key result
BP response correlated with changes in uric acid following hydrochlorothiazide (r=-0.18; P=0.003) and HDL following atenolol (r=0.18; P=0.002), but not with other adverse metabolic effects.
Why the study?
Do adverse metabolic effects correlate with blood pressure response in uncomplicated hypertensives treated with hydrochlorothiazide or atenolol?
RCT (n=569)
Open-label
random assignment
Yes
Do adverse metabolic effects correlate with blood pressure response in uncomplicated hypertensives treated with hydrochlorothiazide or atenolol?
Blood pressure response correlates with changes in uric acid following HCTZ therapy and HDL following atenolol therapy, but not with other metabolic effects, indicating patients should be monitored for adverse metabolic effects regardless of their blood pressure response.
Answers are grounded in this paper and cite their sources.
Metabolic monitoring remains essential regardless of BP response; confirms dissociation of most adverse effects from efficacy with HCTZ or atenolol.
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.
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Smith et al. (2011) conducted an RCT in uncomplicated hypertension (n=569). Hydrochlorothiazide (HCTZ) vs. Atenolol was evaluated on Correlation between increases in uric acid and reductions in systolic BP following HCTZ monotherapy (r = -0.18, p=0.003). BP response correlated with changes in uric acid following hydrochlorothiazide (r=-0.18; P=0.003) and HDL following atenolol (r=0.18; P=0.002), but not with other adverse metabolic effects.
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