The emerging problem of plasma lipid changes during antihypertensive therapy.

After hypertension and smoking, abnormalities of plasma lipids are major coronary risk factors. Increases in low density lipoprotein (LDL) cholesterol, or decreases in high density lipoprotein (HLD) cholesterol or the ratio HDL/LDL are associated with increased risk. Whereas LDL delivers cholesterol to arterial wall cells. HDL aids clearance and/or inhibits uptake of LDL cholesterol. Some agents used to reduce risks of high blood pressure can also disturb lipoprotein levels and may increase associated coronary risk levels. Thiazides increase triglycerides (TG) and increase total cholesterol. However, the HDL/LDL ratio shows no important change in our recent studies.TG elevation may result from increased synthesis secondary to increased plasma levels of glucose and insulin. In several studies, propranolol also caused elevation of TG. This has been the most consistent finding in the few studies of other beta blockers, including metoprolol, atenolol, and pindolol. These studies have generally shown no change in total cholesterol, but some showed reduction in HDL cholesterol in patients on propranolol.