Skip to main content
PMC home page
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1986 Aug;145(2):210–218.

The Effects of Diuretics and Adrenergic-Blocking Agents on Plasma Lipids

John D Brunzell 2, James J Rohlfing 1
PMCID: PMC1306877  PMID: 2876554

Abstract

Antihypertensive medications cause the following changes in plasma lipids and lipoproteins: Thiazide and loop diuretics increase triglyceride, total cholesterol and low-density-lipoprotein (LDL) cholesterol levels with no change in high-density-lipoprotein (HDL) cholesterol. β-Adrenergic antagonists increase triglyceride and decrease HDL cholesterol levels. A rise in very-low-density-lipoprotein (VLDL) cholesterol balances the decrease in HDL cholesterol, so that there is no significant change in total cholesterol. α-Adrenergic antagonists decrease triglyceride, increase HDL cholesterol and may decrease VLDL and LDL cholesterol. Labetalol, with both α- and β-adrenergic antagonistic activity, does not affect plasma lipids in a small number of studies. The calcium channel blockers nifedipine and verapamil also have no consistent effect on lipoprotein levels in a small number of studies.

Full text

PDF
210

Images in this article

211Figure 1.
on p.211

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amery A., Birkenhäger W., Bulpitt C., Clement D., Deruyttere M., De Schaepdryver A., Dollery C., Fagard R., Forette F., Forte J. Influence of anti-hypertensive therapy on serum cholesterol in elderly hypertensive patients. Results of trial by the European Working Party on High blood pressure in the Elderly (EWPHE). Acta Cardiol. 1982;37(4):235–244. [PubMed] [Google Scholar]
  2. Ames R. P., Hill P. Increase in serum-lipids during treatment of hypertension with chlorthalidone. Lancet. 1976 Apr 3;1(7962):721–723. doi: 10.1016/s0140-6736(76)93093-2. [DOI] [PubMed] [Google Scholar]
  3. Ashby P., Bennett D. P., Spencer I. M., Robinson D. S. Post-translational regulation of lipoprotein lipase activity in adipose tissue. Biochem J. 1978 Dec 15;176(3):865–872. doi: 10.1042/bj1760865. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Ballantyne D., Ballantyne F. C., McMurdo Effect of slow oxprenolol and a combination of slow oxprenolol and cyclopenthiazide on plasma lipoproteins. Atherosclerosis. 1981 Jun;39(3):301–306. doi: 10.1016/0021-9150(81)90016-2. [DOI] [PubMed] [Google Scholar]
  5. Beinart I. W., Cramp D. G., Pearson R. M., Havard C. W. The effect of metoprolol on plasma lipids. Postgrad Med J. 1979 Oct;55(648):709–711. doi: 10.1136/pgmj.55.648.709. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bielmann P., Leduc G. Effects of metoprolol and propranolol on lipid metabolism. Int J Clin Pharmacol Biopharm. 1979 Sep;17(9):378–382. [PubMed] [Google Scholar]
  7. Birnbaum J., DiBianco R., Becker K. L., Muesing R., Costello R. B., Singh S. N., Gottdiener J. S., Fletcher R. D. Glucose and lipid metabolism during acebutolol and propranolol therapy of angina in nondiabetic patients. Clin Pharmacol Ther. 1983 Mar;33(3):294–300. doi: 10.1038/clpt.1983.36. [DOI] [PubMed] [Google Scholar]
  8. Bloomgarden Z. T., Ginsberg-Fellner F., Rayfield E. J., Bookman J., Brown W. V. Elevated hemoglobin A1c and low-density lipoprotein cholesterol levels in thiazide-treated diabetic patients. Am J Med. 1984 Nov;77(5):823–827. doi: 10.1016/0002-9343(84)90518-7. [DOI] [PubMed] [Google Scholar]
  9. Boehringer K., Weidmann P., Mordasini R., Schiffl H., Bachmann C., Riesen W. Menopause-dependent plasma lipoprotein alterations in diuretic-treated women. Ann Intern Med. 1982 Aug;97(2):206–209. doi: 10.7326/0003-4819-97-2-206. [DOI] [PubMed] [Google Scholar]
  10. Brunzell J. D., Albers J. J., Haas L. B., Goldberg A. P., Agadoa L., Sherrard D. J. Prevalence of serum lipid abnormalities in chronic hemodialysis. Metabolism. 1977 Aug;26(8):903–910. doi: 10.1016/0026-0495(77)90009-9. [DOI] [PubMed] [Google Scholar]
  11. Brunzell J. D., Bierman E. L. Chylomicronemia syndrome. Interaction of genetic and acquired hypertriglyceridemia. Med Clin North Am. 1982 Mar;66(2):455–468. doi: 10.1016/s0025-7125(16)31430-4. [DOI] [PubMed] [Google Scholar]
  12. Brunzell J. D., Hazzard W. R., Porte D., Jr, Bierman E. L. Evidence for a common, saturable, triglyceride removal mechanism for chylomicrons and very low density lipoproteins in man. J Clin Invest. 1973 Jul;52(7):1578–1585. doi: 10.1172/JCI107334. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Cheung M. C., Albers J. J. Distribution of cholesterol and apolipoprotein A-I and A-II in human high density lipoprotein subfractions separated by CsCl equilibrium gradient centrifugation: evidence for HDL subpopulations with differing A-I/A-II molar ratios. J Lipid Res. 1979 Feb;20(2):200–207. [PubMed] [Google Scholar]
  14. Crisp A. J., Kennedy P. G., Hoffbrand B. I., Ebbutt A. F., Carruthers M. Lipids and lipoprotein fractions after cyclopenthiazide and oxprenolol: a double-blind crossover study. Curr Med Res Opin. 1980;7(2):101–103. doi: 10.1185/03007998009112034. [DOI] [PubMed] [Google Scholar]
  15. Day J. L., Metcalfe J., Simpson C. N. Adrenergic mechanisms in control of plasma lipid concentrations. Br Med J (Clin Res Ed) 1982 Apr 17;284(6323):1145–1148. doi: 10.1136/bmj.284.6323.1145. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Day J. L., Simpson N., Metcalfe J., Page R. L. Metabolic consequences of atenolol and propranolol in treatment of essential hypertension. Br Med J. 1979 Jan 13;1(6156):77–80. doi: 10.1136/bmj.1.6156.77. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Dujovne C. A., DeCoursey S., Krehbiel P., Jackson B., Chernoff S. Serum lipids in normo- and hyperlipidemics after methyldopa and propranolol. Clin Pharmacol Ther. 1984 Aug;36(2):157–162. doi: 10.1038/clpt.1984.156. [DOI] [PubMed] [Google Scholar]
  18. Eliasson K., Lins L. E., Rössner S. Serum lipoprotein changes during atenolol treatment of essential hypertension. Eur J Clin Pharmacol. 1981;20(5):335–338. doi: 10.1007/BF00615401. [DOI] [PubMed] [Google Scholar]
  19. England J. D., Hua A. S., Shaw J. beta-Adrenoreceptor-blocking agents and lipid metabolism. Clin Sci Mol Med Suppl. 1978 Dec;4:323s–324s. doi: 10.1042/cs055323s. [DOI] [PubMed] [Google Scholar]
  20. England J. D., Simons L. A., Gibson J. C., Carlton M. The effect of metoprolol and atenolol on plasma high density lipoprotein levels in man. Clin Exp Pharmacol Physiol. 1980 May-Jun;7(3):329–333. doi: 10.1111/j.1440-1681.1980.tb00078.x. [DOI] [PubMed] [Google Scholar]
  21. Faergeman O., Meinertz H., Hansen J. F. Serum lipoproteins after treatment with verapamil for 6 months. Acta Med Scand Suppl. 1984;681:49–51. doi: 10.1111/j.0954-6820.1984.tb08677.x. [DOI] [PubMed] [Google Scholar]
  22. Friedewald W. T., Levy R. I., Fredrickson D. S. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972 Jun;18(6):499–502. [PubMed] [Google Scholar]
  23. Glück Z., Baumgartner G., Weidmann P., Peheim E., Bachmann C., Mordasini R., Flammer J., Keusch G. Increased ratio between serum beta- and alpha-lipoproteins during diuretic therapy: an adverse effect? Clin Sci Mol Med Suppl. 1978 Dec;4:325s–328s. doi: 10.1042/cs055325s. [DOI] [PubMed] [Google Scholar]
  24. Glück Z., Weidmann P., Mordasini R., Bachmann C., Riesen W., Peheim E., Keusch G., Meier A. Increased serum low-density lipoprotein cholesterol in men treated short-term with the diuretic chlorthalidone. Metabolism. 1980 Mar;29(3):240–245. doi: 10.1016/0026-0495(80)90065-7. [DOI] [PubMed] [Google Scholar]
  25. Goldman A. I., Steele B. W., Schnaper H. W., Fitz A. E., Frohlich E. D., Perry H. M., Jr Serum lipoprotein levels during chlorthalidone therapy. A Veterans Administration-National Heart, Lung, and Blood Institute cooperative study on antihypertensive therapy: mild hypertension. JAMA. 1980 Oct 10;244(15):1691–1695. doi: 10.1001/jama.244.15.1691. [DOI] [PubMed] [Google Scholar]
  26. Goto Y. Effects of alpha- and beta-blocker antihypertensive therapy on blood lipids: a multicenter trial. Am J Med. 1984 Feb 27;76(2A):72–78. doi: 10.1016/0002-9343(84)90959-8. [DOI] [PubMed] [Google Scholar]
  27. Grimm R. H., Jr, Leon A. S., Hunninghake D. B., Lenz K., Hannan P., Blackburn H. Effects of thiazide diuretics on plasma lipids and lipoproteins in mildly hypertensive patients: a double-blind controlled trial. Ann Intern Med. 1981 Jan;94(1):7–11. doi: 10.7326/0003-4819-94-1-7. [DOI] [PubMed] [Google Scholar]
  28. Helgeland A., Hjermann I., Leren P., Enger S., Holme I. High-density lipoprotein cholesterol and antihypertensive drugs: the Oslo study. Br Med J. 1978 Aug 5;2(6134):403–403. doi: 10.1136/bmj.2.6134.403. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Helgeland A. Treatment of mild hypertension: a five year controlled drug trial. The Oslo study. Am J Med. 1980 Nov;69(5):725–732. doi: 10.1016/0002-9343(80)90438-6. [DOI] [PubMed] [Google Scholar]
  30. Hooper P. L., Woo W., Visconti L., Pathak D. R. Terbutaline raises high-density-lipoprotein-cholesterol levels. N Engl J Med. 1981 Dec 10;305(24):1455–1457. doi: 10.1056/NEJM198112103052406. [DOI] [PubMed] [Google Scholar]
  31. Johnson B. F., Romero L., Johnson J., Marwaha R. Comparative effects of propranolol and prazosin upon serum lipids in thiazide- treated hypertensive patients. Am J Med. 1984 Feb 27;76(2A):109–112. doi: 10.1016/0002-9343(84)90967-7. [DOI] [PubMed] [Google Scholar]
  32. Karmakoski J., Viikari J., Rönnemaa T. Effect of pindolol on serum lipoproteins in patients with coronary heart disease. Int J Clin Pharmacol Ther Toxicol. 1983 Apr;21(4):189–191. [PubMed] [Google Scholar]
  33. Kather H., Säuberlich P. Comparison of in vitro and in vivo effects of prazosin on lipid metabolism. Am J Med. 1984 Feb 27;76(2A):89–93. doi: 10.1016/0002-9343(84)90962-8. [DOI] [PubMed] [Google Scholar]
  34. Kaumann A. J., Blinks J. R. beta-Adrenoceptor blocking agents as partial agonists in isolated heart muscle: dissociation of stimulation and blockade. Naunyn Schmiedebergs Arch Pharmacol. 1980 Apr;311(3):237–248. doi: 10.1007/BF00569403. [DOI] [PubMed] [Google Scholar]
  35. Kirkendall W. M., Hammond J. J., Thomas J. C., Overturf M. L., Zama A. Prazosin and clonidine for moderately severe hypertension. JAMA. 1978 Dec 1;240(23):2553–2556. [PubMed] [Google Scholar]
  36. Kjeldsen S. E., Eide I., Leren P., Foss O. P., Holme I., Eriksen I. L. The effect on HDL cholesterol of oxprenolol and atenolol. Scand J Clin Lab Invest. 1982 Sep;42(5):449–453. [PubMed] [Google Scholar]
  37. Lasser N. L., Grandits G., Caggiula A. W., Cutler J. A., Grimm R. H., Jr, Kuller L. H., Sherwin R. W., Stamler J. Effects of antihypertensive therapy on plasma lipids and lipoproteins in the Multiple Risk Factor Intervention Trial. Am J Med. 1984 Feb 27;76(2A):52–66. doi: 10.1016/0002-9343(84)90957-4. [DOI] [PubMed] [Google Scholar]
  38. Lehtonen A., Hietanen E., Marniemi J., Peltonen P., Niskanen J. Effect of pindolol on serum lipids and lipid metabolizing enzymes. Br J Clin Pharmacol. 1982;13(Suppl 2):445S–447S. doi: 10.1111/j.1365-2125.1982.tb01955.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Lehtonen A., Marniemi J. Effect of atenolol on plasma HDL cholesterol subfractions. Atherosclerosis. 1984 May-Jun;51(2-3):335–338. doi: 10.1016/0021-9150(84)90181-3. [DOI] [PubMed] [Google Scholar]
  40. Lehtonen A., Viikari J. Long-term effect of sotalol on plasma lipids. Clin Sci (Lond) 1979 Dec;57 (Suppl 5):405s–407s. doi: 10.1042/cs057405s. [DOI] [PubMed] [Google Scholar]
  41. Leren P., Foss P. O., Helgeland A., Hjermann I., Holme I., Lund-Larsen P. G. Effect of propranolol and prazosin on blood lipids. The Oslo Study. Lancet. 1980 Jul 5;2(8184):4–6. doi: 10.1016/s0140-6736(80)92888-3. [DOI] [PubMed] [Google Scholar]
  42. Lloyd-Mostyn R. H., Lefevre D., Lord P. S., Doig E., Krikler D. M. The effect of beta-adrenergic blocking agents on serum lipids. Atherosclerosis. 1971 Sep-Oct;14(2):283–287. doi: 10.1016/0021-9150(71)90057-8. [DOI] [PubMed] [Google Scholar]
  43. Lowenstein J., Neusy A. J. Effects of prazosin and propranolol on serum lipids in patients with essential hypertension. Am J Med. 1984 Feb 27;76(2A):79–84. doi: 10.1016/0002-9343(84)90960-4. [DOI] [PubMed] [Google Scholar]
  44. Mauersberger H. Effect of prazosin on blood pressure and plasma lipids in patients receiving a beta-blocker and diuretic regimen. Am J Med. 1984 Feb 27;76(2A):101–104. doi: 10.1016/0002-9343(84)90965-3. [DOI] [PubMed] [Google Scholar]
  45. McGonigle R. J., Williams L., Murphy M. J., Parsons V. Labetalol and lipids. Lancet. 1981 Jan 17;1(8212):163–163. doi: 10.1016/s0140-6736(81)90759-5. [DOI] [PubMed] [Google Scholar]
  46. Meltzer V. N., Goldberg A. P., Tindira C. A., Naumovich A. D., Harter H. R. Effects of prazosin and propranolol on blood pressure and plasma lipids in patients undergoing chronic hemodialysis. Am J Cardiol. 1984 Jan 27;53(3):40A–45A. doi: 10.1016/0002-9149(84)90835-x. [DOI] [PubMed] [Google Scholar]
  47. Meyer-Sabellek W., Heitz J., Arntz J. R., Schulte K. L., Gotzen R. The influence of indapamide on serum lipoproteins in essential hypertension. Methods Find Exp Clin Pharmacol. 1984 Aug;6(8):471–474. [PubMed] [Google Scholar]
  48. Miller G. J., Miller N. E. Plasma-high-density-lipoprotein concentration and development of ischaemic heart-disease. Lancet. 1975 Jan 4;1(7897):16–19. doi: 10.1016/s0140-6736(75)92376-4. [DOI] [PubMed] [Google Scholar]
  49. Miller N. E., Hammett F., Saltissi S., Rao S., van Zeller H., Coltart J., Lewis B. Relation of angiographically defined coronary artery disease to plasma lipoprotein subfractions and apolipoproteins. Br Med J (Clin Res Ed) 1981 May 30;282(6278):1741–1744. doi: 10.1136/bmj.282.6278.1741. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Mordasini R., Glück Z., Weidmann P., Keusch G., Meyer A., Riesen W. Zur Pathogenese der Diuretika-induzierten Hyperlipoproteinämie. Klin Wochenschr. 1980 Apr 1;58(7):359–363. doi: 10.1007/BF01477278. [DOI] [PubMed] [Google Scholar]
  51. Murphy M. B., Sugrue D., Trayner I., Kaufman S., Yasuhara H., Dollery C. T., Thompson G. R. Effects of short term beta adrenoreceptor blockade on serum lipids and lipoproteins in patients with hypertension or coronary artery disease. Br Heart J. 1984 Jun;51(6):589–594. doi: 10.1136/hrt.51.6.589. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Nilsson A., Hansson B. G., Hökfelt B. Beta-blockers and lipid metabolism. Br Med J. 1977 Jul 9;2(6079):126–126. doi: 10.1136/bmj.2.6079.126-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Pagnan A., Pessina A. C., Hlede M., Zanetti G., Dal Palu' C. Effects of labetalol on lipid and carbohydrates metabolism. Pharmacol Res Commun. 1979 Mar;11(3):227–236. doi: 10.1016/s0031-6989(79)80084-3. [DOI] [PubMed] [Google Scholar]
  54. Pasotti C., Capra A., Fiorella G., Vibelli C., Chierichetti S. M. Effects of pindolol and metoprolol on plasma lipids and lipoproteins. Br J Clin Pharmacol. 1982;13(Suppl 2):435S–439S. doi: 10.1111/j.1365-2125.1982.tb01953.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Rosenthal T., Holtzman E., Segal P. The effect of chlorthalidone on serum lipids and lipoproteins. Atherosclerosis. 1980 May;36(1):111–115. doi: 10.1016/0021-9150(80)90204-x. [DOI] [PubMed] [Google Scholar]
  56. Rouffy J., Jaillard J. Comparative effects of prazosin and atenolol on plasma lipids in hypertensive patients. Am J Med. 1984 Feb 27;76(2A):105–108. doi: 10.1016/0002-9343(84)90966-5. [DOI] [PubMed] [Google Scholar]
  57. Rössner S., Weiner L. Atenolol and metoprolol: comparison of effects on blood pressure and serum lipoproteins, and side effects. Eur J Clin Pharmacol. 1983;24(5):573–577. doi: 10.1007/BF00542203. [DOI] [PubMed] [Google Scholar]
  58. Scherstén B., Thulin T., Kuylenstierna J., Engström M., Karlberg B. E., Tolagen K., Nordlander S., Nilsson G. Clinical and biochemical effects of spironolactone administered once daily in primary hypertension. Multicenter Sweden study. Hypertension. 1980 Sep-Oct;2(5):672–679. doi: 10.1161/01.hyp.2.5.672. [DOI] [PubMed] [Google Scholar]
  59. Shaw J., England J. D., Hua A. S. Beta-blockers and plasma triglycerides. Br Med J. 1978 Apr 15;1(6118):986–986. doi: 10.1136/bmj.1.6118.986-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Simons L. A., England J. D., Balasubramaniam S., Viles L. Long-term treatment with slow release oxprenolol alone, or in combination with other drugs: effects on blood pressure, lipoproteins and exercise performance. Aust N Z J Med. 1982 Dec;12(6):612–616. doi: 10.1111/j.1445-5994.1982.tb02648.x. [DOI] [PubMed] [Google Scholar]
  61. Sommers D. K., de Villiers L. S., van Wyk M., Schoeman H. S. The effects of labetalol and oxprenolol on blood lipids. S Afr Med J. 1981 Sep 5;60(10):379–380. [PubMed] [Google Scholar]
  62. Streja D., Mymin D. Effect of propranolol on HDL cholesterol concentrations. Br Med J. 1978 Nov 25;2(6150):1495–1495. doi: 10.1136/bmj.2.6150.1495-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Takabatake T., Ohta H., Maekawa M., Yamamoto Y., Ishida Y., Hara H., Hattori N. Effects of long-term prazosin therapy on lipoprotein metabolism in hypertensive patients. Am J Med. 1984 Feb 27;76(2A):113–116. doi: 10.1016/0002-9343(84)90968-9. [DOI] [PubMed] [Google Scholar]
  64. Tanaka N., Sakaguchi S., Oshige K., Niimura T., Kanehisa T. Effect of chronic administration of propranolol on lipoprotein composition. Metabolism. 1976 Oct;25(10):1071–1075. doi: 10.1016/0026-0495(76)90014-7. [DOI] [PubMed] [Google Scholar]
  65. Waal-Manning H. J. Metabolic effects of beta-adrenoreceptor blockers. Drugs. 1976;11(Suppl 1):121–126. doi: 10.2165/00003495-197600111-00027. [DOI] [PubMed] [Google Scholar]
  66. Walldius G. Effect of verapamil on serum lipoproteins in patients with angina pectoris. Acta Med Scand Suppl. 1984;681:43–48. doi: 10.1111/j.0954-6820.1984.tb08676.x. [DOI] [PubMed] [Google Scholar]
  67. Weidmann P., Meier A., Mordasini R., Riesen W., Bachmann C., Peheim E. Diuretic treatment and serum lipoproteins: effects of tienilic acid and indapamide. Klin Wochenschr. 1981 Apr 1;59(7):343–346. doi: 10.1007/BF01525002. [DOI] [PubMed] [Google Scholar]
  68. Wright A. D., Barber S. G., Kendall M. J., Poole P. H. Beta-adrenoceptor-blocking drugs and blood sugar control in diabetes mellitus. Br Med J. 1979 Jan 20;1(6157):159–161. doi: 10.1136/bmj.1.6157.159. [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Wright E. E., Simpson E. R. Inhibition of the lipolytic action of beta-adrenergic agonists in human adipocytes by alpha-adrenergic agonists. J Lipid Res. 1981 Nov;22(8):1265–1270. [PubMed] [Google Scholar]
  70. van Brummelen P., Gevers Leuven J. A., van Gent C. M. Influence of hydrochlorothiazide on the plasma levels of triglycerides, total cholesterol and HDL-cholesterol in patients with essential hypertension. Curr Med Res Opin. 1979;6(1):24–29. doi: 10.1185/03007997909109394. [DOI] [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES