Long-term effects on plasma lipids of diet and drugs to treat hypertension.
1996
Grimm R.H. Jr. | Flack J.M. | Grandits G.A. | Elmer P.J. | Neaton J.D. | Cutler J.A. | Lewis C. | McDonald R. | Schoenberger J. | Stamler J.
Objective.-To compare long-term plasma lipid changes among 6 antihypertensive treatment interventions for stage I (mild) hypertension. Design. Multicenter, randomized, double-blind, parallel-group clinical trial. Setting. Four academic clinical research units in the United States. Participants. A total of 902 men and women, aged 45 to 69 years, with stage I diastolic hypertension (diastolic blood pressure <100 mm Hg), recruited from 11,914 persons screened in their communities. Interventions. Participants were randomized to 1 of 6 treatment groups: (1) placebo, (2) beta-blocker (acebutolol), (3) calcium antagonist (amlodipine). (4)diuretic (chlorthalidone), (5) alpha 1-antagonist (doxazosin), and (6) angiotensin-converting enzyme inhibitor (enalapril). All groups received intensive lifestyle counseling to achieve weight loss, dietary sodium and alcohol reduction, and increased physical activity. Main Outcome Measures. Changes in plasma total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides from baseline to annual visits through 4 years. Results. Mean changes in all plasma lipids were favorable in all groups. The degree of weight loss with fat-modified diet and exercise was significantly related to favorable lipid changes. Significant differences (P<.01) among groups for average changes during follow-up in each lipid were observed. Decreases in plasma total cholesterol and LDL cholesterol were greater with doxazosin and acebutolol (for plasma total cholesterol, 0.36 and 0.30 mmol/L [13.8 and 11.7 mg/dL], respectively), less with chlorthalidone and placebo (0.12 and 0.13 mmol/L [4.5 and 5.1 mg/dL], respectively) Decreases in triglycerides were greater with doxazosin and enalapril, least with acebutolol. Increases in HDL cholesterol were greater with enalapril and doxazosin, least with acebutolol.
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