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Are Blood Pressure Medications Bad for My Cholesterol?

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Updated September 02, 2008

Question: Are Blood Pressure Medications Bad for My Cholesterol?
Answer:

Some high blood pressure medications have been shown to slightly worsen cholesterol profiles.

Beta blockers are the high blood pressure medicine most commonly associated with raising cholesterol. Studies have shown that some beta blockers can increase triglyceride levels and decrease the level of HDL (“good”) cholesterol. The effect of these beta blockers on LDL (“bad”) cholesterol is inconclusive. Some studies have shown reductions in LDL levels, while others have shown increases.

The cholesterol raising effects of beta blockers are primarily limited to older beta blockers like metoprolol and atenolol. Newer beta blockers, like carvedilol, do not seem to have this effect. Even with the older versions, the cholesterol-raising effects are very small, and do not affect everyone.

Research has demonstrated that only specific types of patients seem to experience any cholesterol increase while being treated with beta blockers. Those most likely to be affected are patients with preexisting metabolic syndrome.

In addition to beta blockers, some studies suggest that high doses of certain diuretics can also increase both triglycerides and total cholesterol. Thiazide diuretics are most likely to have this effect. Unlike beta blockers, the cholesterol raising effect of thiazide diuretics can affect anyone, though the total change is still very small.

This is an interesting issue because, generally, doctors worry about cholesterol levels because higher cholesterol has been conclusively linked to an increased risk of heart attack and other “cardiovascular events.” Studies disagree, though, on whether slightly increased cholesterol in this specific situation confers increased heart risks. The emerging picture seems to be that the positive effects from the medicine more than outweigh the negative effects of the increased cholesterol, meaning that people taking the medicines are still better off than those who aren’t.

Still, the newer drugs are preferred as initial treatment options if high blood pressure is the only problem. In some patients with heart disease or other specific risk factors, research has shown that the most benefit is still obtained from using older drugs like atenolol because these drugs prevent other problems in addition to treating the high blood pressure.

Sources:

Ingle L, Rigby AS, Carroll S, Butterly R, King RF, Cooke CB, Cleland JG, Clark AL.Changes in body composition in patients with left ventricular systolic dysfunction initiated on beta-blocker therapy. Exp Clin Cardol. 2007 Spring;12(1):46-7.

Baumhäkel M, Schlimmer N, Büyükafsar K, Arikan O, Böhm M.Nebivolol, but not metoprolol, improves endothelial function of the corpus cavernosum in apolipoprotein e-knockout mice. J Pharmacol Exp Ther. 2008 Jun;325(3):818-23.

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