Effects of First Line Antihypertensive Drugs on Salivary Gland Function

Aside from a few well controlled clinical studies most evidence of low level, originating mainly from case reports and small series, indicate that hypofunction of salivary glands is the most common side effect of antihypertensive drugs. Therefore, in the present cross-sectional randomized study in a large series of patients we investigated the influence of different first line antihypertensive drugs on salivary gland function in hypertensive patients with and without diabetes mellitus (DM) type 2.

Method:

447 subjects (mean age: 63.14±7.76; both genders) were recruited from the Zvezdara University Medical Center, Belgrade and Health Center "Dr Jovan Jovanovic Zmaj", Stara Pazova: 60 healthy subjects (control group) and 387 hypertensive patients (treated with enalapril - ACE inhibitor, metoprolol – selective beta₁-blocker, hydrochlorothiazide - diuretic or their combinations) including 91 with DM type 2. Salivary gland function was measured subjectively as xerostomia (interview) and objectively as unstimulated whole saliva flow rate (UWSFR) by spitting method.

Result:

Significantly less frequent xerostomia and absence of effect on UWSFR were observed with enalapril, while metoprolol, hydrochlorothiazide and combinations of enalapril with them caused significant xerostomia and decrease of UWSFR. Among investigated hypertensive patients, binary logistic regression analysis found that age, gender, DM type 2 and all investigated drugs, except enalapril as monotherapy, are risk factors predicting low UWSFR and xerostomia.

Conclusion:

From first line antihypertensive drugs only enalapril slightly influences salivary gland function while this influence was significant and more pronounced in DM type 2 with metoprolol, hydrochlorothiazide and theirs combinations with enalapril, suggesting that this side effect of drugs is influenced by DM type 2.

This study was supported by the Serbian Ministry of Education and Science, Grant No. 175021.