998-119 Should We Worry About the Hypercholesterolemic Effects of Anti-Hypertensive Medications?

Several large studies have demonstrated improved morbidity and mortality with lowering of blood pressure (BP) in hypertension (HTN). The drugs which have been shown to lower BP and cardiovascular (CV) risk are beta blocking agents and thiazide diuretics. In spite of the documented benefit from the use of these agents, there is a tendency among some physicians to avoid these two classes of drugs when treating HTN. One of the reasons quoted is that both of these classes of drugs increase cholesterol levels, which is postulated to negate the CV risk reduction afforded by BP lowering. This study was undertaken to determine the magnitude of benefit from the lowering of BP with these drugs and compare it with the expected loss of benefit due to increased cholesterol levels with these drugs. A decision analysis was constructed utilizing a new life expectancy (LE) function. L1FESPANS (Lagrange Interpolated Functions of Empirical Survival Percentages Approximated by NEVADA Simulations) is designed to individualize mortality prediction utilizing mortality data from the National Center for Health Statistics and numerous large epidemiological studies. Modifiable factors which are included in this model to assist in the survival prediction include: age, sex, race, BP cholesterol level, current smoking history, and body mass index. For the initial analysis, a 10% reduction in BP with a 5% increase in absolute cholesterol level with these agents was assumed. Sensitivity analyses were performed for a wide range of initial BPs, cholesterol levels and smoking history. Reduction of BP with either of these agents resulted in 1–5 years of additional LE depending on baseline conditions. Significant increases in LE were predicted even in the elderly. A 5% rise in cholesterol, in contrast, was associated with a 0.0–0.6 year decrease in LE. The reduction in LE for increased cholesterol was at most 28% of the increase in LE due to BP lowering. Women had a slightly greater reduction of LE from increased cholesterol In conclusion, without taking the other metabolic effects of these agents into consideration, the increase in CV risk due to the small predicted increase in cholesterol only partially negates the benefits of BP lowering. These predictions are based on studies utilizing high dose (50–100mg) diuretics. Lower doses will have even less effect on lipid profiles and the negative LE changes in hypertensive patients