Side effects of antihypertensives

The following antihypertensive agents are linked with well recognised side effects EXCEPT which one?

a) Lisinopril may cause angioedema

b) Metoprolol may cause impotence

c) Diltiazem may cause insulin resistance

d) Bendroflumethiazide may cause hyperuricaemia

e) Losartan may cause a dry cough


 

Answer: c
 

Explanation

A lot of development has gone into improving antihypertensives’ side-effects profiles,

as the pathology itself often exists without symptoms. A drug that makes a patient feel

symptomatic is less likely to be a clinical and commercial success due to noncompliance.

Mild side effects due to antihypertensives, such as headache and lethargy,

are common. Lisinopril has been known to cause angioedema. This potentially lifethreatening

side effect occurs in about 0.1 to 0.2% of patients on lisinopril. All the betablockers

may cause impotence. Lisinopril commonly produces a dry cough (97% of

cases), and although this is much less common with losartan (18%) it may also trouble

patients. Hyperuricaemia with thiazide use is well described.

Even though there have been a few isolated case reports linking diltiazem with

insulin resistance, a clinical trial showed no effect on circulating glucose or insulin

levels in patients on diltiazem, and another showed an improvement in insulin levels in

insulin-resistant patients started on insulin. It would certainly not be identified as a

recognised side effect.

Reference

Chan P, Tomlinson B, Huang TY, et al. Double-blind comparison of losartan, lisinopril,

and metolazone in elderly hypertensive patients with previous angiotensin-converting

enzyme inhibitor-induced cough. J Clin Pharmacol 1997; 37(3): 253–7.