Disclosures LB and FR have received research funding from nutraceutical companies however the latter were not involved in any aspect of this review.
Article first published online: 26 DEC 2012
© 2012 John Wiley & Sons Ltd
International Journal of Clinical Practice
Volume 67, Issue 8, pages 717–725, August 2013
How to Cite
Braun, L. A. and Rosenfeldt, F. (2013), Pharmaco-nutrient interactions – a systematic review of zinc and antihypertensive therapy. International Journal of Clinical Practice, 67: 717–725. doi: 10.1111/ijcp.12040
- Issue published online: 22 JUL 2013
- Article first published online: 26 DEC 2012
- Paper received June 2012, accepted September 2012
Background: Antihypertensive medicines are to known to cause diverse disturbances to electrolyte homeostasis; however, their potential to affect zinc is less well known. The primary aim was to explore whether antihypertensive medicines have the potential to affect zinc status.
Methods: A review of electronic databases was undertaken. Full-length English language articles describing clinical trials involving antihypertensive medicines and reporting on zinc measurements were reviewed.
Results: Eight eligible studies were identified which involved the use of ACE inhibitors, thiazide diuretics, beta blockers, or ARB drugs of which five included a control group Studies used urinary zinc excretion, plasma zinc levels or erythrocyte zinc as key measures of zinc status.
Studies reported increased urinary zinc losses for captopril (from 50 mg/day), enalapril (20 mg/day), losartan (50 mg/day), losartan (50 mg/day) together with hydrochlorothiazide (12.5 mg/day), captopril (75 mg/day) together with frusemide (40 mg/day) and stand-alone hydrochlorothiazide (25 mg/day). Serum levels of zinc decreased with captopril (50–150 mg/day), verapamil (240 mg/day), atenolol (50–150 mg/day) and the combination of losartan (50 mg/day) and hydrochlorothiazide (12.5 mg/day), eryrthrocyte levels decreased with use of valsartan (80 mg/day) and in some studies for captopril, but not for metoprolol (100 mg/day), atenolol (50–150 mg/day), verapamil (240 mg/day), doxazosin (4 mg/day) or amlodipine 10 mg/day).
Major limitations were that most studies were small and did not report on dietary zinc intake.
Conclusion: The available evidence suggests that use of ACE inhibitors and angiotensin 2 receptor antagonists or thiazide diuretics have the potential to reduce zinc levels in hypertensive patients. Additional research using larger participant numbers and accounting for dietary zinc intakes are required.