Effects of Amlodipine and Hydrochlorothiazide Combination Therapy on Lipid Profiles in Hypertensive Nigerians

Abstract

There is paucity of information regarding the effects of combination therapy with amlodipine and hydrochlorothiazide on lipid profiles in hypertensive Nigerians. Therefore, to evaluate whether this combination therapy would ameliorate or aggravate the known metabolic adversity of hydrochlorothiazide on lipid parameters, 90 male and female Nigerians aged 31-86 years with newly diagnosed uncomplicated essential hypertension (blood pressure > 160/90 ≤ 180/120mmHg) were enrolled into a randomised 48-week study. Treatment was initiated in the patients, who were 30 each in amlodipine, hydrochlorothiazide and amlodipine-hydrochlorothiazide groups, with amlodipine 5mg, hydrochlorothiazide 25mg and amlodipine 5mg + hydrochlorothiazide 25mg, respectively. Body mass index, blood pressure and lipid profiles were evaluated at baseline as well as at the end of weeks 1, 3, 6, 12, 24, 36 and 48. The 3 regimens significantly (p<0.05) reduced blood pressure. At the end of week 48, mean male/female % significant decrease or increase in lipid parameters in amlodipine, hydrochlorothiazide and amlodipine-hydrochlorothiazide groups were, respectively:-4.3/-1.5, 2.8/3.7 and 2.6/2.5, p<0.0001 for total cholesterol;-7.2/-2.6, 5.3/5.6 and 6.6/6.2, p<0.0001 for triglyceride; 16.5/19.6,-12.0/-8.6 and-7.8/-8.4, p<0.0001 for high density lipoprotein cholesterol;-4.6/-3.0, 5.6/11.7 and 4.5/8.0, p<0.0001 for low density lipoprotein cholesterol. This study demonstrates that beyond reducing blood pressure, amlodipine and hydrochlorothiazide combination therapy has varied effects on lipid panel and it also suggests that, with regard to cardiovascular risk profile, it may be preferable to initiate treatment with a regimen of amlodipine to which hydrochlorothiazide is subsequently added, instead of a regimen of hydrochlorothiazide to which amlodipine is later added or a regimen of ab initio amlodipinehydrochlorothiazide combination therapy.

A Randomized Controlled Trial of the Effects of Aerobic Dance Training on Blood Lipids Among Individuals with Hypertension on a Thiazide

“…In fact, addition of hydrochloride amiloride to hydrochlorothiazide (HCT) to form a thiazide does not change its effects on lipid profile [6]. Furthermore, combination of amlodipine and hydrochlorothiazide taken for 48 weeks has been reported to lower HDL-C, and increase triglyceride, LDL-C and TC in a sample of Nigerians with hypertension [8]. Going by these possible effects of thiazides, it could be inferred that favourable effects of aerobic exercise on this serum lipid levels might have been attenuated, and hence the difference in between-group findings compare to some previous studies.…”

“…Furthermore, several other factors may influence effect of exercise training on serum lipid levels, and these include initial fitness level, pretraining lipoprotein levels, low BMI, fat-tissue weight, age and gender of participants, diet, smoking habits, and socioeconomic factors [32]. Administration of hydrochlorothiazide and amlodipine, has also been reported to lower HDL-C [8]. In addition, intra-individual biological variability is a major factor in the measurement of lipids, lipoproteins, or apolipoproteins [33].…”

“…Thiazide diuretics have been reported to cause a marked elevation in plasma triglyceride and minor increases in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), but have little effects on highdensity lipoprotein cholesterol (HDL-C) [1,8,9]. In fact, addition of hydrochloride amiloride to hydrochlorothiazide to form co-amilozide does not change the effects of thiazides on lipid profile [6].…”

تثبيط جملة الرينين-أنجيوتنسين يحسن الصيغة اللبيدية لدى مرضى الداء الكلوي المزمن

“…Iyalomhe et al [23] showed that in hypertensive Nigerian patients, amlodipine monotherapy dramatically reduced TC, TG, LDL, and improved HDL-C mean values while amlodipine and hydrochlorothiazide combination therapy significantly increased TC and TG as well as lowered HDL values. This discovery of amlodipine's greater therapeutic advantages may be related to its pleiotropic activities, which are independent of BP lowering and include anti-atherosclerotic, anti-oxidant, antiinflammatory, and potentiation of nitric oxide activity.…”