Metabolic effects of lisinopril versus hydrochlorothiazide plus amiloride in essential hypertension

A multicenter, randomized, double-blind, parallel-group trial was conducted to compare the effects of long-term treatment with lisinopril versus hydrochlorothiazide plus amiloride on lipids, glucose, uric acid, and electrolytes in patients with mild to moderate essential hypertension. After 6 months of treatment with hydrochlorothiazide 50 to 100 mg plus amiloride 5 to 10 mg or lisinopril 10 to 20 mg given once daily, the patients receiving the diuretics showed an increase in triglycerides, very-low-density lipoproteins, and apolipoproteins A and B, while the patients receiving lisinopril had only minimal changes in these parameters and an increase in high-density lipoproteins. Serum uric acid levels rose significantly in the group receiving diuretics but did not change in the lisinopril group. The antihypertensive effect was similar for both drug regimens. These data show that the long-acting angiotensin converting enzyme inhibitor lisinopril did not induce any metabolic effects and should be preferred, as a first choice, to antihypertensive drugs such as diuretics, which may cause lipid and uric acid metabolism disorders