[Effects of beta blockers on lipoprotein metabolism]

Abstract

Problem: With respect to prevention of its most common complication--mortality from coronary heart disease--treatment of hypertension had disappointed. It is possible that this is due to negative effects of antihypertensives on lipid metabolism.

Major topics: The effects of beta blockers on lipid metabolism can be differentiated principally, in accordance with the classification of beta blockers into those with and those without intrinsic sympathomimetic activity (ISA), as also selectivity and non-selectivity. Thus, non-selective beta blockers with no ISA usually lead to an increase in triglycerides of 25% to 30%, and a decrease in HDL cholesterol of about 15%. On average, beta-1 selective blockers result in a smaller increase in triglycerides. Beta blockers with ISA, in contrast, are largely neutral vis-à-vis lipid metabolism. In the individual case, in particular in the presence of hyperlipoproteinemia, the effects cannot be reliably predicted.

Conclusions: Lipoprotein concentrations should be monitored during treatment with beta blockers. If necessary, a change in the agent employed is recommended. In the case of prevention of a second myocardial infarction, for which various studies have unequivocally shown a reduction in mortality associated with treatment with beta blockers with no ISA, these side effects will, however, be accepted--with the exception of extreme changes--for a limited period of time.