Key result
Enalapril avoids adverse lipid effects compared to Timolol, which increases triglycerides by ~35%.
Why the study?
Does enalapril compared to timolol improve blood lipid profiles in hypertensive patients?
RCT (n=120)
single-blind
randomized
Yes
Does enalapril compared to timolol improve blood lipid profiles in hypertensive patients?
Enalapril has a neutral effect on lipid metabolism, whereas timolol adversely affects lipid profiles and uric acid levels in hypertensive patients.
Enalapril may be preferred over timolol in hypertensives with lipid concerns; confirms ACE inhibitors' metabolic neutrality versus beta-blockers' adverse effects.
In a 24-week randomized, single-blind study Timolol (n = 63) and Enalapril (n = 57) proved to be potent and safe antihypertensive drugs. However, the effect on lipid metabolism was fundamentally different, despite the fact that the effect on total serum cholesterol did not significantly differ between the two groups. Enalapril had no adverse effect on any lipid fractions, while Timolol increased very low (VLDL) + low (LDL) density lipoprotein cholesterol by 7.6% (p less than 0.001) and total triglycerides by 34.5% (p less than 0.001), and decreased the favorable high density lipoprotein (HDL) cholesterol by 11.3% (p less than 0.001). Thus, the ratio HDL/VLDL + LDL cholesterol was reduced by 17.1% (p less than 0.001). Enalapril reduced uric acid by 3.4% (NS), while Timolol increased uric acid by 4.0% (p less than 0.05). The difference between the groups was statistically significant (p less than 0.01). The first steps in any attempt to solve the hypertension-coronary dilemma should be to take into consideration all pharmacologic effects of antihypertensive drugs.
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Leren et al. (1988) conducted an RCT in Hypertension (n=120). Enalapril vs. Timolol was evaluated on Lipid metabolism. Enalapril had no adverse effect on lipids, whereas Timolol increased VLDL+LDL cholesterol by 7.6% and triglycerides by 34.5%, and decreased HDL cholesterol by 11.3% (all p<0.001).
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