Elekeh et al
Greener Journal of Medical Sciences Vol. 7 (1), pp. 012-017, February 2017.
Manuscript Number: 111212249
A Comparison of the effects of fixed dose Valsartan/Hydrochlorothiazide and Atenolol/Chlorthalidone on Blood Lipid Profile in Hypertensive Patients
Elekeh BB1, Ughachukwu PO2, Unekwe PC3, Ogamba JO3
1Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, Abia State University, Uturu, Nigeria.
2Department of Pharmacology and Therapeutics. College of Medicine, Anambra State University, Awka Campus, Anambra State Nigeria.
3Department of Pharmacology and Therapeutics, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria.
Background: Hypertension is the commonest non-communicable disease and the leading cause of cardiovascular disease in the world. Antihypertensive therapy often produces plasma lipid and glucose derangements. This study, therefore, was designed to find antihypertensive combinations that do not adversely affect plasma lipid and glucose profiles. Method: 240 carefully selected hypertensive patients of both sexes aged between 35-64 years were divided into two groups A and B. Baseline values of systolic and diastolic blood pressure, fasting blood sugar, serum total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride and reduced glutathione (GSH) were recorded. Fixed dose combinations of valsartan 80mg +hydrochlorothiazide 12.5mg (Diovan-HCT) and atenolol 50mg +chlorthalidone 12.5mg ( Diovan-50) were administered orally once daily to group A and group B subjects respectively. Post-treatment values were recorded at the end of six weeks. Results: The valsartan+hydrochlorothiazide combination produced a statistically significant higher reduction in diastolic blood pressure, plasma LDL-C, HDL-C, and triglyceride and a minimal increase in fasting blood compared with atenolol + chlorthalidone combination (p = 0.0001 for all variables). Conclusion: Valsartan + hydrochlorothiazide combination produced a better control of diastolic blood pressure with a favourable effect on FBS, plasma total cholesterol, LDL-C, HDL-C, and GSH.
Keywords: Blood pressure, valsartan/hydochlorothiazide, atenolol/chlorthalidone, lipid profile, blood sugar, glutathione.
Ahaneku G.I., Osuji C.U., Anisiuba B.C., Ikeh V.O., Oguejiofor O.C. and Ahaneku J.E., (2011). Evaluation of blood pressure and indices of obesity in a typical rural community in eastern Nigeria. Ann. Afr. Med. 10 (2): 120-6.
Allain C.C., Poon L.S., Chain C.S.G., Richmond W,. and Fu P.C., (1974). Enzymatic etermination of the serum cholesterol. Clin. Chem. 20(4): 470–475.
Barham D. and Trinder P., (1972). Clinical guide to laboratory test. Analyst 97: 142.
Barzilay J.I., Davis B.R., Cutler J.A., Pressel S.L., Whelton P.K., Basile J., Margolis KL., Ong S.T., Sadler L.S. and Summerson J., (2006). Fasting glucose levels and incident diabetes mellitus in older non-diabetic adults randomized to receive 3 different classes of antihypertensive treatment: a report from the Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial (ALLHAT). Ach. Intern. Med. 166(20): 2191-2201.
Benson S.C., Pershadsingh H.A., Chittiboyina A., Desai P., Pravenec M., Qi N., Wang J., Avery M.A. and Kurtz T.W., (2004). Identification of telmisartan as a unique angiotensin II receptor antagonist with selective PPAR gamma-modulating activity. Hypertension 43(5): 993-1002.
Beutler E., Duron O. and Kelly M., (1963). Improved method for the determination of blood glutathione. J.Lab. Clin. Med. 61: 882-888.
Bolterman R.J., Manriquiz M., Luis A.J., Ruiz M.C.O. and Romero J.C., (2005). Effects of captopril on the renninangiotensin system, oxidative stress endothelin in normal and hypertensive rats. Hypertension 46 (4): 943- 947.
Burt V., (2000). Prevalence of hypertension in the US adult population: Result from the third National Health and Nutrition Examination Survey, 1988-2000. Hypertension 25 (3):303-313.
Chobanian V., Bakis J., Black H., Cushman W., Green C. and Gad J., (2003). Seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure. The JNC 7th report. JAMA 289(9): 2360.
Cruickshank J.M., (2007). Are we misunderstanding beta-blockers. Int. J. Cardiol. 120 (1): 10-27.
Dorsch M.P., Gillespic B.W., Erickson S.R., Bleske B.E. and Weder A.B., (2011). Chlorthalidone reduces cardiovascular events compared with hydrochlorothiazide: a retrospective cohort analysis Hypertension 57 (4): 689-694.
Ejike C., Ugwu C., Ezeanyika C. and Olayemi A., (2008). Blood pressure pattern in relation to geographic area of residence: A cross sectional study of adolescents in Enugu State, Nigeria. BMI Public Health 8(1): 411.
Fujiwara W., Izawa H., Ukai G., Yokoi H., Mukaide D., Kinoshita K., Morimoto S.I., Ishii J., Ozaki Y. and Nomura M., (2012). Low dose of hydrochlorothiazide, in combination with angiotension receptor blocker, reduces blood pressure effectively without adverse effect on glucose and lipid profiles. Heart Vessels (Epub ahead of print). Available at: http:www.ncbinlm.nih.gov/pubmed/22447467.
Gotto J. and Antonio M., (2005). Evolving concepts of dyslipidemia, atherosclerosis and cardiovascular disease; the Louis F. Bishop lecture. J. Am. Coll. Cardiol. 46(7): 1219-1224.
Kearney PM., Whelton M., Reynolds K., Muntner P., Whelton PK. and He J., (2005). Global burden of hypertension: analysis of world wide data. Lancet 365(9455): 217-223.
Kuster G.M., Amann F.W., Neuenschwander C. and Drexel H., (2002). High density-lipoprotein sub-fractions in patients using cardio-selective beta-blockers. Cardiovasc. Drugs. Ther. 16 (2): 121-131.
Kwelou S.M., Vyssaelis G.P., Karpanou E.A., Adamopuolos D.N., Zervoudaki A.I., Pietri P.G,.and Stetanadis C.L., (2006). Effects of antihypertensive treatment with angiotersin II receptor blockers on lipid profile: an open multi-drug comparison trial. Helenic. J. Cardiol. 47 (1): 21-28.
Lopez-Virella MF., Store P. and Ellis S., (1977). Cholesterol determination in high- density lipoprotein separated by three different methods. Clin. Chem. 23:882-884.
National Institute on Health, 2004. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure. NIH Publication No. 04-5230. pp 1-2.
Ott S.M., LaCroix A.Z., Ichikawa L.E., Scholes D., Barlow W.E., (2003). Effect of low dose thiazide diuretics on plasma lipids: results from a double-blind, randomized clinical trial in older men and women. J. Am. Geriatr. Soc. 51(3): 340-347.
Pareek A., Karnik N., Salagre S.B., Zawar S.D., Joglekar V.K., Chandurkar N. and Naik G.S., (2008). Clinical effectiveness of low-dose chlorthalidone (6.25mg) + atenolol combination in stage/hypertensive patients: a multicentre, randomized, controlled study. Curr. Med. Res. Opin. 24 (6): 1771-1779.
Poirier L. and Lacourciere Y., (2012). The evolving role of β-adrenergic receptor blockers in managing hypertension. Can. J. Cardiol. 28 (3): 334-340.
Rabin I., Bechara A., Andress P., Pratibha C., Joshi C., Michael H., Ann S., Brown R. and David M., (2005). Angiotensin mediates glutathione depletion, transforming growth factor expression and epithelial barrier dysfunction in the alcoholic rat lung. Am. J. Physiol. Lung. Cell. Mol. Physiol. 289: 363-370.
Roush G.C., Holford T.R. and Guddati A.K., (2012). Chlorthalidone compared with hydrochlorothiazide in reducing cardiovascular events: systematic review and network meta analysis. Hypertension 59(6): 1110- 1117.
Silva J., Filipe P., Fernandes A. and Manso C., (1998). Antioxidant effects of drugs used in cardiovascular therapy. Rev. Port. Cardiol. 17(6): 495-503.
Stears A.J., Woods S.H., Watts M.M., Burton T.J., Graggaber J., Mir F.A. and Brown M.J., (2012). A double blind, placebo controlled, crossover trial comparing the effects of amiloride and hydrochlorothiazide on glucose tolerance in patients with essential hypertension. Hypertension 59 (5): 934-942.
Tietz N.W., (1986). Textbook of clinical chemistry. Philadelphia, W.B.Saunders Company. P.888.
Townsend D.M., Tew K.D. and Tapiero H., (2003). The importance of glutathione in human disease. Biomed Pharmacother 57: 145-155.
Van der Zijl N.J., Moors C.C., Goossens G.H., Hermans M.M., Blaak E.E. and Diamant M., (2011). Valsartan improves beta-cell function and insulin sensitivity in subjects with impaired glucose metabolism: a randomized control trial. Diabetes Care 34 (4): 845-851.
Weiland H,. and Seidel D., (1983). A simple method for precipitation of low- density lipoproteins. J. Lipid Res. 24: 904-909.
World Health Organization (2002). World Health Report. Reducing risks, promoting healthy living. Available at: http://www.who.int/whr/2002. (Accessed May 5, 2011).
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