TY - JOUR
T1 - The metabolic cost of lowering blood pressure with hydrochlorothiazide
AU - Price, Angela L.
AU - Lingvay, Ildiko
AU - Szczepaniak, Edward W.
AU - Wiebel, Jaime
AU - Victor, Ronald G.
AU - Szczepaniak, Lidia S.
N1 - Funding Information:
This study was funded as the investigator initiated research award to LSS and RGB by Novartis.
Funding Information:
This study was supported in part by Novartis Investigator Initiated Award, NIH UL1RR024982, NIH K23 RR024470, R01 NIDDK081524.
PY - 2013
Y1 - 2013
N2 - Background: The landmark Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) placed a new spotlight on thiazide diuretics as the first-line therapy for hypertension. This is concerning as thiazide-diuretics may contribute to comorbidities associated with the current epidemic of obesity. Previous randomized clinical trials have linked thiazide diuretic treatment to insulin resistance, metabolic syndrome, and increased incidence of type 2 diabetes. Methods. This proof of concept, longitudinal, randomized, double-blind study evaluated the effects of the angiotensin II receptor blocker Valsartan and the specific thiazide diuretic Hydrochlorothiazide (HCTZ) on hepatic triglyceride level (primary outcome), as well as triglyceride levels within other organs including the heart, skeletal muscle, and pancreas. Additionally, we evaluated whether myocardial function, insulin sensitivity, and insulin secretion were affected by these treatments. Results: Hepatic TG levels increased by 57% post HCTZ treatment: hTG §ssub§HCTZ§esub§ = 4.12% and remained unchanged post Valsartan treatment: hTG §ssub§V§esub§ = 0.06%. The elevation of hepatic TG levels after HCTZ treatment was additionally accompanied by a reduction in insulin sensitivity: SI §ssub§HCTZ§esub§ = -1.14. Treatment with Valsartan resulted in improved insulin sensitivity: SI §ssub§V§esub§ = 1.24. Treatment-induced changes in hepatic TG levels and insulin sensitivity were statistically significant between groups (p§ssub§hTG§esub§ = 0.0098 and p§ssub§SI§ esub§ = 0.0345 respectively). Disposition index, DI, remained unchanged after HCTZ treatment: DI §ssub§HCTZ§esub§ = -141 but it was increased by a factor of 2 after treatment with Valsartan: DI §ssub§V§esub§ =1018). However, the change between groups was not statistically significant. Both therapies did not modify abdominal visceral and subcutaneous fat mass as well as myocardial structure and function. Additionally, myocardial, pancreatic, and skeletal muscle triglyceride deposits remained unchanged in both therapeutic arms. Conclusions: Our findings are two-fold and relate to hepatic steatosis and insulin sensitivity. HCTZ treatment worsened hepatic steatosis measured as hepatic triglyceride content and reduced insulin sensitivity. Valsartan treatment did not affect hepatic triglyceride levels and improved insulin sensitivity. The results of this study reinforce the message that in patients at risk for type 2 diabetes it is particularly important to choose an antihypertensive regimen that lowers blood pressure without exacerbating patient's metabolic profile.
AB - Background: The landmark Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) placed a new spotlight on thiazide diuretics as the first-line therapy for hypertension. This is concerning as thiazide-diuretics may contribute to comorbidities associated with the current epidemic of obesity. Previous randomized clinical trials have linked thiazide diuretic treatment to insulin resistance, metabolic syndrome, and increased incidence of type 2 diabetes. Methods. This proof of concept, longitudinal, randomized, double-blind study evaluated the effects of the angiotensin II receptor blocker Valsartan and the specific thiazide diuretic Hydrochlorothiazide (HCTZ) on hepatic triglyceride level (primary outcome), as well as triglyceride levels within other organs including the heart, skeletal muscle, and pancreas. Additionally, we evaluated whether myocardial function, insulin sensitivity, and insulin secretion were affected by these treatments. Results: Hepatic TG levels increased by 57% post HCTZ treatment: hTG §ssub§HCTZ§esub§ = 4.12% and remained unchanged post Valsartan treatment: hTG §ssub§V§esub§ = 0.06%. The elevation of hepatic TG levels after HCTZ treatment was additionally accompanied by a reduction in insulin sensitivity: SI §ssub§HCTZ§esub§ = -1.14. Treatment with Valsartan resulted in improved insulin sensitivity: SI §ssub§V§esub§ = 1.24. Treatment-induced changes in hepatic TG levels and insulin sensitivity were statistically significant between groups (p§ssub§hTG§esub§ = 0.0098 and p§ssub§SI§ esub§ = 0.0345 respectively). Disposition index, DI, remained unchanged after HCTZ treatment: DI §ssub§HCTZ§esub§ = -141 but it was increased by a factor of 2 after treatment with Valsartan: DI §ssub§V§esub§ =1018). However, the change between groups was not statistically significant. Both therapies did not modify abdominal visceral and subcutaneous fat mass as well as myocardial structure and function. Additionally, myocardial, pancreatic, and skeletal muscle triglyceride deposits remained unchanged in both therapeutic arms. Conclusions: Our findings are two-fold and relate to hepatic steatosis and insulin sensitivity. HCTZ treatment worsened hepatic steatosis measured as hepatic triglyceride content and reduced insulin sensitivity. Valsartan treatment did not affect hepatic triglyceride levels and improved insulin sensitivity. The results of this study reinforce the message that in patients at risk for type 2 diabetes it is particularly important to choose an antihypertensive regimen that lowers blood pressure without exacerbating patient's metabolic profile.
KW - Hydrochlorothiazide
KW - Insulin secretion
KW - Insulin sensitivity
KW - Proton magnetic resonance spectroscopy
KW - Type 2 diabetes
KW - Valsartan
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U2 - 10.1186/1758-5996-5-35
DO - 10.1186/1758-5996-5-35
M3 - Article
C2 - 23837919
AN - SCOPUS:84880008759
SN - 1758-5996
VL - 5
JO - Diabetology and Metabolic Syndrome
JF - Diabetology and Metabolic Syndrome
IS - 1
M1 - 35
ER -