on November 16, 2009
Published online before print November 16, 2009, doi: 10.1161/HYPERTENSIONAHA.109.139592
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Submitted on July 22, 2009
From the Colleges of Pharmacy (R.M.C.-D., S.W., J.G.G., Y.G., J.A.J.) and Medicine (R.M.C.-D., J.G.G., K.H., J.A.J.) and Center for Pharmacogenomics (R.M.C.-D., S.W., J.G.G., Y.G., J.A.J.), University of Florida, Gainesville, Fla; School of Medicine (A.L.B.), University of Maryland, Baltimore, Md; US Food and Drug Administration (I.Z.), Silver Spring, Md; Mayo Clinic College of Medicine (S.T.T.), Rochester, Minn; Morehouse School of Medicine (V.P.), Atlanta, Ga; School of Medicine (A.B.C.), Emory University, Atlanta, Ga; Human Genetics Center and Institute of Molecular Medicine (E.B.), University of Texas at Houston, Houston, Tex. * To whom correspondence should be addressed. E-mail: dehoff{at}cop.ufl.edu.
Abstract—We assessed adverse metabolic effects of atenolol and hydrochlorothiazide among hypertensive patients with and without abdominal obesity using data from a randomized, open-label study of hypertensive patients without evidence of cardiovascular disease or diabetes mellitus. Intervention included randomization to 25 mg of hydrochlorothiazide or 100 mg of atenolol monotherapy followed by their combination. Fasting glucose, insulin, triglycerides, high-density lipoprotein cholesterol, and uric acid levels were measured at baseline and after monotherapy and combination therapy. Outcomes included new occurrence of and predictors for new cases of glucose
Revised on August 9, 2009
Impact of Abdominal Obesity on Incidence of Adverse Metabolic Effects Associated With Antihypertensive Medications
Rhonda M. Cooper-DeHoff*;
100 mg/dL (impaired fasting glucose), triglyceride 150 mg/dL, high-density lipoprotein 
40 mg/dL for men or 50 mg/dL for women, or new-onset diabetes mellitus according to the presence or absence of abdominal obesity. Abdominal obesity was present in 167 (58%) of 395 patients. Regardless of strategy, in those with abdominal obesity, 20% had impaired fasting glucose at baseline compared with 40% at the end of study (P<0.0001). Proportion with triglycerides 150 mg/dL increased from 33% at baseline to 46% at the end of study (P<0.01). New-onset diabetes mellitus occurred in 13 patients (6%) with and in 4 patients (2%) without abdominal obesity. Baseline levels of glucose, triglyceride, and high-density lipoprotein predicted adverse outcomes, and predictors for new-onset diabetes mellitus after monotherapy in those with abdominal obesity included hydrochlorothiazide strategy (odds ratio: 46.91 [95% CI: 2.55 to 862.40]), female sex (odds ratio: 31.37 [95% CI: 2.10 to 468.99]), and uric acid (odds ratio: 3.19 [95% CI: 1.35 to 7.52]). Development of adverse metabolic effect, including new-onset diabetes mellitus associated with short-term exposure to hydrochlorothiazide and atenolol was more common in those with abdominal obesity.
Key words: atenolol • hydrochlorothiazide • abdominal obesity • metabolic syndrome • new-onset diabetes mellitus • hypertension
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Hypertension 2010 55: 15-17.
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  C. Manrique, M. Johnson, and J. R. Sowers Thiazide Diuretics Alone or With {beta}-Blockers Impair Glucose Metabolism in Hypertensive Patients With Abdominal Obesity Hypertension, January 1, 2010; 55(1): 15 - 17. [Full Text] [PDF]
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