Summary
We have studied 250 patients with mild to moderate essential hypertension (diastolic blood pressure 95 – 114 mmHg) and dyslipidaemia (high-density lipoprotein cholesterol (HDL-C) below 1.03 mmol·l−1, total cholesterol 5.17–9.05 mmol·l−1, and triglycerides 2.26–5.64 mmol·l−1) in a controlled double-blind, multicentre, parallel group trial.
The patients took a fat-modified diet. After a 4-week placebo period, patients who continued to fulfil the selection criteria were randomly allocated to treatment with either carvedilol (a vasodilating β-blocker) 25–50 mg o.d. (n=116) or captopril (an ACE inhibitor) 25–50 mg o.d. (n=117) for 6 months.
In both groups there were favourable effects on the serum lipids. The relative changes (medians) in the carvedilol and captopril group were respectively: increase in HDL-C by 11% and 8%, decrease in total cholesterol by 11% and 10%, in low-density lipoprotein cholesterol by 16% and 12%, and in triglycerides by 13% and 14%. Equivalence of the two treatments was confirmed for the target variable change in HDL-C at a significance level of 5%.
Reductions in supine systolic/diastolic blood pressures were comparable in the two groups (carvedilol: 23/19 mmHg, captopril: 20/18 mmHg).
The improvement in lipid metabolism in patients treated with carvedilol is probably due to its α1-blocking properties.
Similar content being viewed by others
References
Stamler I, Wentworth D, Neatan ID (1986) Prevalence and prognostic significance of hypercholesterolemia in men with hypertension. Prospective data on the primary screeners of the multiple risk factor intervention trial. Am J Med 80 [Suppl 2A]: 33–39
Kannel WB, Castelli WP, Gordon TL (1976) Cholesterol in the prediction of atherosclerotic disease: new perspectives based on the Framingham study. Ann Intern Med 90: 85–91
Samuelsson O, Wilhelmsen L, Andersson OK, Pennert K, Berglund G (1987) Cardiovascular morbidity in relation to change in blood pressure and serum cholesterol levels in treated hypertension. JAMA 258: 1768–1776
Lipid Research Clinics Program (1984) The Lipid Research Clinics Coronary Primary Prevention Trial results. II The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA 251: 365–374
Manninen V, Elo MO, Frick MH, Haapa K, Heihonen OP, Heinsalmi P, Helo P, Huttunen JK, Kaitaniemi P, Koskinen P, Mäenpää H, Mälkönen M, Mänttäri M, Norola S, Pasternack A, Pikkarainen J, Romo M, Sjöblom T, Nikkilä EA (1988) Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study. JAMA 260: 641–651
Krönig B, Widmann L, Staiger C, Machwirth M, Stienen U, Hennig M, Müller-Beckmann B (1990) Blood pressure-lowering effect of carvedilol vs nitrendipine in geriatric hypertensives. Eur J Clin Pharmacol 38 [Suppl 2]: S167-S170
Sponer G, Bartsch W, Strein K, Müller-Beckmann B. Kling L (1988) Mode of vasodilating activity of carvedilol in isolated perfused hind limbs of rabbits. Drugs 36 [Suppl 6]: 55–61
Kannel WB, Carter BL (1989) Initial drug therapy for hypertensive patients with dyslipidemia. Am Heart J 188: 1012–1021
Assmann G, Lewis B, Mancini M, Paoletti R, Schettler G (1987) Strategies for the prevention of coronary heart disease: a policy statement of the European Atherosclerosis Society Study Group, European Atherosclerosis Society. Eur Heart J 8: 77–88
Grimm RH, Hunninghakl DB (1986) Lipids and hypertension. Am J Med 80: 56–63
Neusy AJ, Lowenstein J (1986) Effects of prazosin, atenolol and thiazide diuretic on plasma lipids in patients with essential hypertension. Am J Med 80: 94–99
Berne C (1991) Metabolic effects of ACE inhibitors. J Intern Med 229 [Suppl 2]: 119–125
Friedewald WT, Levy RI, Freckrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without the use of the preparative ultracentrifuge. Clin Chem 18: 499–505
The Treatment of Mild Hypertension Research Group (1991) The Treatment of Mild Hypertension study. A randomised, placebo-controlled trial of a nutritional-hygienic regimen along with various drug monotherapies. Arch Intern Med 151: 1413–1423
Pollare T, Lithell H, Selinus I, Berne C (1989) Sensitivity to insulin during treatment with atenolol and metoprolol; a randomised double-blind study of effects on carbohydrate and lipoprotein metabolism in hypertensive patients. BMJ 298: 1152–1157
Pollare T, Lithell H, Mörlin C, Präntare H, Hvarfner A, Ljunghall S (1989) Metabolic effects of diltiazem and atenolol: results from a randomised double-blind study with parallel groups. J Hypertens 7: 551–559
Leren P, Foss PO, Nordvik B, Fossbakk B (1988) The effect of enalapril and timolol on blood lipids. Acta Med Scand 223: 321–326
Pollare T, Lithell H, Selinus I, Berne C (1988) Application of prazosin is associated with an increase of insulin sensitivity in obese patients with hypertension. Diabetologia 31: 415–420
Wessels F (1991) Double-blind comparison of doxazosin and enalapril in patients with mild or moderate essential hypertension. Am Heart J 121: 299–303
Talseth T, Westlie L, Daae L, Vatle S (1988) Comparison of the effects of doxazosin and atenolol on blood pressure and blood lipids: a one-year, double-blind study in 228 hypertensive patients. Am Heart J 116: 1790–1796
Frick MH, Cox DA, Himanen P, Huttunen M, Pitkäjärvi T, Pörsti P, Pöyhönen L, Pyykönen M-L, Reinikainen P, Salmela P, Saraste M (1987) Serum lipid changes in a one-year, multi-centre, double-blind comparison of doxazosin and atenolol for mild to moderate essential hypertension. Am J Cardiol 59: 61 G-67 G
Pollare T, Lithell H, Berne C (1989) A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension. New Engl J Med 321: 868–873
Weinberger MH (1983) Influence of an angiotensin converting enzyme inhibitor in diuretic-induced metabolic effects in hypertension. Hypertension 5 [Suppl III]: III-132-III-138
Weinberger MH (1985) Blood pressure and metabolic responses to hydrochlorothiazide, captopril and the combination in black and white mild-to-moderate hypertensive patients. J Cardiovasc Pharmacol 7: S52-S55
Foss OP, Jensen EK (1990) The effect of captopril and metoprolol as monotherapy or combined with bendroflumethiazide on blood lipids. J Intern Med 227: 119–123
Okun R, Kraut J (1987) Prazosin versus captopril as initial therapy. Effect on hypertension and lipid levels. Am J Med 82 [Suppl 1A]: 58–63
Ghirlanda G, Uccioli L, Solini A, Cotroneo P, Manto A, Botta G, Greco AV (1987) Hypertension and dyslipidemia: captopril therapy and twelve months' follow-up. Curr Ther Res 42: 948–953
Saltvedt E, Andreassen P, Dahl K, Dyb S, Flogstad T, Hallan H, Josephsen J, Moum B, Sandersen S, Sandvei P, Torvik D, Wessel-Aas T, Widerøe TE (1986) An improved serum lipid profile in hypertensives during captopril treatment (abstract). Postgrad Med J 62 [Suppl 1]: 78
Costa F, Borghi C, Mussi A (1988) Use of captopril to reduce serum lipids in hypertensive patients with dyslipidemia. Am J Hypertens 1 [Suppl]: 221–223
Durrington PN (1990) Biological variation in serum lipid concentrations. Scan J Clin Lab Invest 198 [Suppl]: 86–91
Cooper GR, Myers GL, Smith SJ, Schlant RC (1992) Blood lipid measurements. JAMA 267: 1652–1660
Cooper GR, Myers GL, Smith SJ, Sampson EJ (1988) Standardization of lipid, lipoprotein and apolipoprotein measurements. Clin Chem 34: B95-B105
Durrington PN (1989) Hyperlipidaemia: diagnosis and management. Wright, London, pp 308
Scherrer U, Nussberger J, Torriani S, Waeber B, Darioli R, Hofstetter JR, Brunner HR (1991) Effect of weight reduction in moderately overweight patients on recorded ambulatory blood pressure and free cytosolic platelet calcium. Circulation 83: 552–558
Curzio JL, Kennedy SS, Elliott HL, Farish E, Barnes JF, Howie CA, Seymour J, Reid JL (1989) Hypercholesterolaemia in treated hypertensives: a controlled trial of intensive dietary advice. J Hypertens 7 [Suppl 6]: S254-S255
Lasser NL, Grandits G, Caggiula AW, Cutler JA, Grimm RH, Kuller LH, Sherwin RW, Stamler J (1984) Effects of antihypertensive therapy on plasma lipids and lipoproteins in the Multiple Risk Factor Intervention Trial. Am J Med 76 [Suppl 2A]: 52–65
Gordon DJ, Trost DC, Hyde J, Whaley FS, Hannan PJ, Jacobs DR, Eklund LG (1987) Seasonal cholesterol cycles: the Lipid Research Clinics Coronary Primary Prevention Trial placebo group. Circulation 76: 1224–1231
Letellier G, Desjarlais F (1982) Study of seasonal variations for eighteen biochemical parameters over a four-year period. Clin Biochem 15: 206–211
Buxtorf JC, Baudet MF, Martin C, Richard JL, Jacotot B (1988) Seasonal variations of serum lipids and apoproteins. Ann Nutr Metab 32: 68–74
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hauf-Zachariou, U., Widmann, L., Zülsdorf, B. et al. A double-blind comparison of the effects of carvedilol and captopril on serum lipid concentrations in patients with mild to moderate essential hypertension and dyslipidaemia. Eur J Clin Pharmacol 45, 95–100 (1993). https://doi.org/10.1007/BF00315487
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00315487