oa Cardiovascular Journal of Africa - The metabolic syndrome and the effects of long-term low-dose diuretics in elderly white hypertensives
Objectives. To determine changes in the metabolic profile of elderly white patients with treated hypertension and the effect of withdrawal of prolonged thiazide therapy. Design. Fifty-eight patients (mean age 66.4 ï¿½ 1.4 years; 12 men, 46 women) treated with antihypertensive agents (including low-dose thiazides) underwent a standard 75 g oral glucose challenge with documentation of serial glucose, fasting insulin and lipid levels. In a subgroup (N = 14), low-dose thiazides were discontinued and the investigations were repeated 10 months later. Results. Twenty-four patients had normal glucose tolerance (NG) and 34 had abnormal glucose tolerance (AG). Of the latter, 9 had unsuspected diabetes mellitus. Total fasting cholesterol and triglyceride concentrations, diastolic blood pressure and recorded duration of hypertension were greater in AG than NG subjects. There was no evidence of more severe target organ damage (ECG or serum creatinine level) in AG than NG subjects. Following withdrawal of low-dose thiazides from a subgroup (N = 14) with AG, no change in glucose or insulin concentrations occurred: There was a statistically significant decrease in total cholesterol (P = 0.03), triglyceride (P = 0.0(1) and LDL cholesterol (P = 0.02) levels; the HDL cholesterol level increased (P = 0.003). Conclusion. Dyslipidaemia was closely related to the use of thiazides, albeit in a low dose, while the high incidence of abnormal glucose tolerance was related to factors other than thiazide use.
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