Comparison of hydrochlorothiazide and atenolol as initial treatment in uncomplicated hypertension

Summary After screening a local population in the northern part of The Netherlands for hypertension, 119 patients with a diastolic pressure (DP) between 95 and 120 mmHg were randomised and treated either with 50 mg hydrochlorothiazide (n=59) or 100 mg atenolol (n=60). After 1 month of treatment 6 patients in the hydrochlorothiazide group and 24 patients in the atenolol group had reached a DP90 mmHg (p<0.001). 43 of the 50 non-responders to hydrochlorothiazide were switched to atenolol and 30 of the 35 non-responders to atenolol were changed to hydrochlorothiazide. One month after the switch 19 patients in the atenolol group and 2 patients in the hydrochlorothiazide group had reached a DP90 mmHg (p<0.001). After 6 months of treatment 32 of the 43 atenolol responders and 7 of the 8 hydrochlorothiazide responders were still receiving the same medication, as their DP was still90 mmHg. Non-responders to either medication were given the combination (n=46). 21 patients now became normotensive as did a further 10 after increasing the dose of atenolol to 200 mg. Thus, in all 70 patients had a blood pressure 90 mmHg after treatment for 4 months. Both drugs induced a significant reduction in the total of number of complaints after 1 month of treatment. They did not differ from each other. The reduction was seen both in responders and non-responders and persisted during treatment for 6 months. It is concluded that in terms of short-term efficacy the cardioselective, hydrophilic beta adrenoceptor-blocking drug atenolol is preferable to hydrochlorothiazide in the treatment of uncomplicated hypertension.     

Efficacy and safety of carvedilol in comparison with atenolol in hypertensive patients pretreated with hydrochlorothiazide

Carvedilol [25 mg once daily] (o. d.) was compared to atenolol (50 mg o. d.) as an adjunct to pre-existing hydrochlorothiazide (HCTZ) monotherapy in patients with mild to moderate hypertension [diastolic blood pressure (DBP),100–115 mm Hg]. After a placebo run-in phase of 2 weeks, 131 patients received 25 mg HCTZ o. d. for 4 weeks. In all, 122 patients were transferred to the double-blind phase, in which 25 mg carvedilol or 50 mg atenolol was randomly added to HCTZ. After an additional 6 weeks of treatment, 112 patients were evaluable for efficacy (C/HCTZ group,n = 54; A/HCTZ group,n = 58). Blood pressure was measured and the heart rate was counted before medication, at 2-week intervals throughout the trial, and 2 h after medication on the 1st and the last day of the combination treatment period. Serum lipids were measured in addition to routine laboratory variables. A therapeutic response was defined as a reduction in supine and standing diastolic blood pressure to values of < 90=" mmhg.=" in=" a=" relatively=" low=" number=" of=" patients=" (6=" of=" 131),=" a=" response=" as=" defined=" above=" was=" achieved=" with=" hctz=" alone.=" this=" may=" be=" accounted=" for=" by=" the=" fact=" that=" patients=" were=" required=" to=" have=" a=" diastolic=" blood=" pressure=" of=" at=" least=" 100=" mghg=" and=" by=" the=" relatively=" short=" period=" of=" monotherapy.=" the=" two=" groups=" of=" patients=" receiving=" different=" combination=" treatments=" were=" well=" matched=" for=" demographic=" data=" and=" blood=" pressure=" values=" before=" the=" adjunct=" was=" added.=" in=" both=" groups=" there=" was=" a=" marked=" additional=" blood=" pressure=" decrease=" on=" the=" initiation=" of=" combined=" treatment.=" at=" the=" end=" of=" the=" study=" the=" medians=" of=" all=" blood=" pressure=" values=" were=" well=" within=" normal=" ranges,=" which=" was=" not=" the=" case=" with=" hctz=" alone.=" on=" the=" last=" day=" of=" the=" trial,=" the=" responders=" comprised=" 67%=" of=" the=" c/hctz=" group=" and=" 71%=" of=" the=" a/hctz=" group.=" no=" relevant=" changes=" in=" lipid=" values=" were=" observed=" with=" combination=" treatment=" vs=" diuretic=" monotherapy.=" no=" serious=" adverse=" event=" attributable=" to=" one=" of=" the=" study=" drugs=" was=" reported.=" the=" results=" of=" the=" present=" trial=" suggest=" that=" the=" antihypertensive=" efficacy=" of=" both=" combinations=" is=" superior=" to=" that=" of=" hctz=" alone=" and=" that=" there=" is=" no=" difference=" in=" efficacy=" between=" the=" two=" combinations.=" adding=" carvedilol=" or=" atenolol=" to=" pre-existing=" hctz=" appears=" to=" be=" safe.=" the=" tolerability=" of=" the=" antihypertensive=" treatment=" does=" not=" seem=" to=" decline,=" despite=" considerable=" additional=" decreases=" in=" blood=">     

Safety and antihypertensive efficacy of carvedilol and atenolol alone and in combination with hydrochlorothiazide

Carvedilol has been shown to be effective and safe in patients with essential hypertension when given as monotherapy. In this double-blind, randomized, group-comparative study, 2 groups of 59 patients with mild to moderate essential hypertension [median supine systolic/diastolic blood pressure at baseline (SBP/DBP), 168/105 mm Hg] were treated with either 25 mg carvedilol once daily (o. d.) or 50 mg atenolol o. d. for 4 weeks. Responders at 4 weeks (DBP, < 90=" mmhg)=" terminated=" the=" study.=" nonresponders=" continued=" the=" study.=" hydrochlorothiazide=" (hctz)=" was=" added=" at=" 25=" mg=" o.=" d.=" for=" a=" further=" 6=" weeks.=" the=" median=" blood=" pressure=" decreased=" under=" monotherapy=" with=" carvedilol=">n = 59) from 167/105 at baseline to 155/94 mmHg after 4 weeks, and in the atenolol group (n=59) it decreased from 168/105 to 162/97 mmHg. The patients who received carvedilol in combination with HCTZ and were evaluated for efficacy (n = 38) showed a decrease in SBP/DBP from 156/97 at the end of monotherapy to 145/88 mmHg after 10 weeks; the combination of atenolol with HCTZ (n = 44) reduced BP from 162/97 to 147/88. Both carvedilol and atenolol were safe when given either alone or in combination with HCTZ. In conclusion, after long-term administration, 25 mg carvedilol o. d. and 50 mg atenolol o. d. significantly reduced both SBP and DBP over 24 h. The addition of HCTZ led to a further increase in antihypertensive efficacy. Combined treatment with carvedilol or atenolol and HCTZ was very well tolerated, without hypotensive events or relevant changes in objective safety parameters.     

Comparison of atenolol 50 mg and 100 mg as initial treatment in uncomplicated mild to moderate hypertension

Summary After screening a local population in the northern part of The Netherlands for hypertension, 59 patients with a diastolic pressure (DP) between 95 and 130 mmHg were randomized and treated either with 50 mg atenolol (n=29) or 100 mg atenolol (n=30) for 1 month. There was no significant difference between the two treatments, neither in the fall in systolic and diastolic pressures nor in the number of complaints reported. It is concluded that in the initial treatment of uncomplicated mild to moderate hypertension, 100 mg atenolol has no advantage over a 50 mg dose.     

静脉滴注拉贝洛尔治疗高血压急症的疗效和安全性

目的：评价静脉滴注拉贝洛尔治疗高血压急症的降压疗效及安全性。方法：31例高血压急症患者接受拉贝洛尔（1－4mg/min,iv gtt）治疗。结果：治疗前血压为23.2／16.5kPa,拉贝洛尔治疗2h后90％（28／31）患者平均血压下降15％－25％,治疗6h后血压控制在21.3／13.3kPa以下者为94％,拉贝洛尔降压起效快县无低血压现象发生。结论：静脉滴注拉贝洛尔治疗高血压急症有效、安全。     

Intraindividual comparison of moxonidine and prazosin in hypertensive patients

Summary Thirty hypertensive outpatients were treated with moxonidine for 4 weeks in an intraindividual comparison study. After a wash-out period of at least 2 weeks the same patients were given prazosin for 4 weeks. The initial daily doses were 0.2 mg moxonidine and 1 mg prazosin. The antihypertensive dose was titrated individually until the diastolic blood pressure (BP) fell below 95 mm Hg.Within 3 days of dose titration, a mean dose of 0.37 mg moxonidine produced a significant decrease in BP from a mean of 184/100 to 155/90 mm Hg, while in prazosin treated patients 5 to 8 days were necessary to reduce the BP from 180/100 to 149/89 mm Hg; the mean prazosin dose was 2.8 mg. In addition to the lower dose of moxonidine compared to prazosin, it was found that in 67% of patients moxonidine was given once daily whilst prazosin was administered three-time daily in 73%.Within the first week of moxonidine treatment 14/30 patients experienced dryness of the mouth, but it was so mild that the patients did not want to discontinue the trial. In contrast, 3/30 patients discontinued therapy with prazosin because of side effects. The most frequent adverse effects of prazosin were orthostatic dysregulation in 6 patients, pain in the chest in 5, giddiness and tachycardia in 4 and nervousness in 3 patients; no patient had these complaints whilst on moxonidine.In intraindividual comparisons with moxonidine, efficacy, tolerance and the well-being of the patients were significantly better than when on prazosin.     

依那普利单用与合用氢氯噻嗪治疗原发性高血压的比较

原发性高血压患者56例(男34,女22;年龄50±7a)采用依那普利2.5-20mg,bid,po,治疗4wk与6mo的疗效比较,两者治疗后均有显著降压疗效(P<0.01),但4wk与6mo治疗组间比较无差异(P>0.05)。副作用亦相仿。另对30例同样患者采用单用依那普利(剂量方法同前)及与氢氯噻嗪2.5-15mg,bid,po,联合治疗4wk作比较,联合用药优于单用组。     

Single and divided daily dose piretanide in the treatment of uncomplicated essential hypertension: A double-blind comparison with a combination of hydrochlorothiazide and amiloride

Summary In a randomised double blind study in patients with mild to moderate hypertension, piretanide 6 mg once and twice daily significantly reduced both supine and erect blood pressure. This was seen after only 2 weeks and a further progressive reduction was evident over the ensuing 12-week trial period. The higher dose produced a mean maximal fall of 29% in supine diastolic pressure, compared with 23% after the lower dose; the difference is not significant. Hydrochlorothiazide 50 mg/amiloride 5 mg twice daily (HCT/A) also reduced supine blood pressure significantly after 2 weeks, but the reduction in erect diastolic blood pressure did not achieve statistical significance until 8 weeks. The maximal effect (a 13% fall in supine diastolic blood pressure) was significantly less than that of either piretanide regimen. Blood pressures in this group also returned more rapidly to pretreatment levels during the placebo washout phase at the end of the study.HCT/A produced a significant sustained rise in serum potassium and a reduction in serum sodium and chloride. Piretanide had minimal effects on serum electrolytes.     

Enalapril and hydrochlorothiazide in hypertensive Africans

Summary The antihypertensive efficacy both of angiotensin converting enzyme (ACE) inhibitors and thiazide diuretics has been claimed to be influenced by plasma renin activity, which declines with age and is low in blacks. In a double-blind, placebo-controlled, double-dummy, randomized, parallel-group preliminary study, the antihypertensive efficacy and tolerability of the ACE inhibitor enalapril (20 mg day^–1) and hydrochlorothiazide (50 mg day^–1) were evaluated and compared for 4 weeks in 20 African patients with essential hypertension. The two groups had similar baseline clinical features and serum Na⁺ and K⁺ levels.Hydrochlorothiazide caused a significant and sustained fall in erect blood pressure with a reflex tachycardia. Enalapril exerted only a modest antihypertensive action, but significantly reduced erect heart rate.Direct comparison of hydrochlorothiazide — and enalapril — induced hypotension suggested a greater fall in subjects on the thiazide. The 95% confidence limits for the thiazide-enalapril difference in antihypertensive action at the end of the study was 39.5 to –7.5 mm Hg systolic and 22.0 to –6.6 mm Hg diastolic. The maximal blood pressure fall after hydrochlorothiazide was positively correlated with age (r=0.50;p<0.05), whilst that of enalapril was inversely related age to (r=–0.57,p<0.05).The results are compatible with the notion that ACE inhibitor monotherapy may be less effective than thiazide diuretic treatment in African and black patients with essential hypertension. The findings also support the concept that age and racial factors may influence the response to antihypertensive treatment.     

Multicentre comparison of the antihypertensive effect of acebutolol and hydrochlorothiazide in uncomplicated mild-moderate hypertension in the elderly

Summary To evaluate the efficacy of acebutolol, 400–600 mg/day in elderly hypertensive patients, and to compare it with hydrochlorothiazide 25–50 mg/day, 45 patients with mild-moderate uncomplicated hypertension were treated for 6 weeks in a multicentre, single-blind, randomized, crossover trial. Acebutolol decreased supine systolic blood pressure from 186.5 to 162.7 mmHg and diastolic blood pressure from 107.4 to 92.4 mmHg. Hydrochlorothiazide decreased systolic blood pressure from 185.0 to 166.4 and diastolic blood pressure from 107.2 to 96.4. There was no difference between the effects of acebutolol and hydrochlorothiazide on blood pressure during the trial. Both drugs proved to be safe and effective antihypertensive agents, provided the major contraindications for their use were taken into account. Beta-blockade by acebutolol was highly effective in treating mild-moderate arterial hypertension in the elderly.     

A double-blind comparison of felodipine and hydrochlorothiazide added to metoprolol to control hypertension

Summary Seventy-six uncomplicated hypertensive patients treated in General Practice, whose seated diastolic blood pressure (Phase V) (dBP) remained 95 mmHg after a minimum of 4 weeks treatment with metoprolol 50 mg b.i.d. as antihypertensive monotherapy, were randomized to receive the selective calcium antagonist felodipine 5 mg b.i.d. or hydrochlorothiazide 12.5 mg b.i.d. in addition to metroprolol 50 mg b.i.d. The trial duration was 8 weeks, the dose of the felodipine or hydrochlorothiazide being doubled after 4 weeks if control of BP (dBP <90 mmHg) was not achieved on the initial doses.Over the trial period of 8 weeks, felodipine reduced dBP from 102 to 85 mmHg and hydrochlorothiazide from 101 to 91 mmHg; the dBP reduction in the felodipine group was greater than that in the hydrochlorothiazide group (17 vs 9 mmHg) and the attained dBP lower in the felodipine group. About half of the patients in each group required the higher dose.Both regimes were effective and well tolerated. In the dosages used, felodipine was a slightly more effective antihypertensive drug than hydrochlorothiazide when added to metoprolol. There was no apparent difference in the tolerability of the two regimes.     

卡维地洛与拉贝洛尔治疗轻、中度高血压病399例的比较

目的：比较国产卡维地洛与拉贝洛尔降压疗效及安全性。方法：轻、中度高血压病病人３９９例（男性 ２２８例,女性 １７１例;年龄 ５２ ａ± ｓ ９ ａ）,其中２００例采用随机、单盲、平行对照方法,卡维地洛与拉贝洛尔组各 １００例,起始剂量分别为 １０ ｍｇ,ｐｏ,ｂｉｄ与 ５０ ｍｇ,ｐｏ, ｂｉｄ, ２ ｗｋ后按血压决定维持原量或增加到 ２０ ｍｇ,ｐｏ, ｂｉｄ或 １００ ｍｐ,ｐｏ, ｂｉｄ,总疗程 ４ ｗｋ。开放组 １９９例服卡维地洛 １０～２０ ｍｇ,ｐｏ, ｂｉｄ × ４ ｗｂ。其中 ４９例延长到 ６ ｍｏ。结果：随机单盲各１００例用药 １ｗｋ血压、心率均明显下降,治疗 ４ ｗｂ总有效率分别为 ７６％及 ６６％,卡维地洛组优于拉贝洛尔组（ Ｐ＜ ０． ０５）。用卡维地洛共 ２９９例总有效率 ８６． ０％。开放组中 ４９例降压从 ４ ｗｋ～６ ｍｏ呈稳定下降。 ２药不良反应依次为 １５％及１３％,均较轻,可耐受。结论： ２药均是治疗轻、中度高血压病的有效而安全的药物,卡维地洛略优于拉贝洛尔。     

阿司匹林联合拉贝洛尔治疗妊娠期高血压的疗效观察

目的探讨阿司匹林肠溶片联合盐酸拉贝洛尔治疗妊娠期高血压的临床疗效。方法选取2016年5月—2018年8月于凉山州第一人民医院收治的妊娠期高血压患者240例作为研究对象,随机将患者分为对照组和治疗组,每组各120例。对照组患者静脉滴注盐酸拉贝洛尔注射液,50 mg溶于5%葡萄糖注射液250 m L中,充分混合,维持剂量为2 mg/min。当血压控制良好并且低于140/90mm Hg时患者口服盐酸拉贝洛尔片,100mg/次,3次/d。治疗组患者在对照组治疗的基础上口服阿司匹林肠溶片,50 mg/d,1次/d。两组患者持续治疗到妊娠前1 d停用。观察两组患者的临床疗效,同时比较两组治疗前后的血压和妊娠结局。结果治疗后,对照组和治疗组的总有效率分别为80.83%、96.67%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者的收缩压和舒张压均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组血压低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组胎儿存活率分别为93.33%、100.00%,两组比较差异具有统计学意义(P0.05)。结论阿司匹林肠溶片联合盐酸拉贝洛尔治疗妊娠期高血压具有较好的临床疗效,可改善患者血压和妊娠结局,值得临床推广使用。     

Fixed combination of sotalol and hydrochlorothiazide in the treatment of uncomplicated hypertension

Summary The combination of sotalol and hydrochlorothiazide in a fixed ratio of 6.4:1 was evaluated in thirty patients with uncomplicated hypertension. In the first part of the study, once daily administration of an optimal dose of the combination was significantly more effective than either hydrochlorothiazide or sotalol alone in lowering both the supine and standing systolic and diastolic blood pressure. Blood pressure was still controlled 24 h after the previous dose. Serum potassium fell by 0.37 mEq/l from the mean pretreatment value after treatment with the combination, but it still remained within the normal range. In the second part of the study the long term effect of the combination on blood pressure, heart rate and biochemical parameters was studied in twenty patients. Supine and standing blood pressure fell by 28.7/15.3 mmHg and 29.5/17.6 mmHg, respectively (p<0.001). Serum potassium was 3.98±0.07 mEq/l after twelve months of therapy; potassium supplements were not administered. Like serum potassium, the other biochemical parameters remained within the normal range. The combination was well tolerated on long term use, and only one patient withdrew from the study.     

不同剂量氢氯噻嗪治疗原发性高血压的疗效观察

目的:观察两种剂量氢氯噻嗪治疗原发性高血压的疗效和安全性。方法:选择门诊1,2级高血压患者106例,随机分为两组,分别给予12.5mg和25mg的氢氯噻嗪,qd,观察8周。比较两种剂量氢氯噻嗪的降压疗效及主要生化指标。结果:(1)降压疗效:12.5mg组和25mg组氢氯噻嗪治疗前后的收缩压和舒张压都有明显下降,差异有显著性(P<0.05)。但降压幅度、总有效率差异无显著性。(2)生化指标:治疗8周后,两组患者均出现血清钾下降及血尿酸增加,但25mg氢氯噻嗪对患者的影响更明显,且出现血糖升高,与治疗前相比差异有显著性(P<0.05)。结论:每日服用12.5mg氢氯噻嗪可有效降低1,2级原发性高血压患者的血压,与25mg组相比,降压作用相当,但对生化影响及出现的不良反应较少。     

A randomized double-blind study of bisoprolol versus atenolol in mild to moderate essential hypertension

Summary We have compared the efficacy and pharmacokinetics of bisoprolol, a new cardioselective beta-adrenoceptor antagonist, with atenolol in a randomized double-blind crossover study in 12 patients (mean age 53.5 y) with mild to moderate essential hypertension. After a two week placebo wash-out period without any antihypertensive therapy, the patients were given bisoprolol 10 mg daily or atenolol 50 mg daily, increasing to 20 mg or 100 mg respectively if the sitting diastolic blood pressure did not fall below 90 mm Hg after two weeks of therapy. Crossover occurred after six weeks of active therapy followed by two weeks of placebo wash-out.After 6 weeks of therapy both drugs significantly reduced sitting and standing diastolic blood pressures (bisoprolol by 15% and 16% respectively, atenolo by 11% in both cases). However, while sitting and standing systolic pressures were significantly reduced by bisoprolol (13% and 16% respectively), only standing systolic pressures were significantly reduced by atenolol (11%), and this reduction was significantly less than with bisoprolol (p<0.05). Both drugs similarly reduced mean sitting and standing heart rates.There were no significant differences between the single-dose and steady-state kinetics of either bisoprolol or atenolol. The mean plasma elimination half-life (t_1/2) increased from 12.9 to 13.2 h during steady state on bisoprolol and from 7.2 to 11.5 h on atenolol. The apparent volume of distribution (V_z) was greater for bisoprolol than for atenolol after single dosing (235 1 vs 146 1) and at steady state (216 1 vs 137 1), but clearances were similar for both drugs. The maximum plasma concentration (C_max) of bisoprolol increased from 45 g·l^–1 to 72 g·l^–1 during steady state and the C_max of atenolol increased from 321 g·l^–1 to 410 g·l^–1 Adverse effects occurred in only one patient (lethargy while taking atenolol).These results suggest that bisoprolol has similar efficacy, safety, and pharmacokinetics to atenolol in patients with mild to moderate essential hypertension.     

贝那普利联合氢氯噻嗪对高血压患者左室重构逆转作用的观察

目的探讨贝那普利联合氢氯噻嗪对高血压患者左室重构逆转作用。方法纳入30例高血压合并左室肥厚的患者,运用贝那普利10mg联合氢氯噻嗪12.5mg治疗,观察4周、8周、12周血压情况及心脏形态学变化情况。结果贝那普利联合氢氯噻嗪治疗后自第四周开始舒张压和收缩压均呈现出下降趋势（P〈0.01）;自第四周开始左室舒张末径（LVDD）、左房前后径（LAD）、室间隔厚度（IVST）、左室后壁厚度（LVPWT）均呈现下降趋势（P〈0.01）,而左心室舒张末期容积（LVEDV）无显著变化。结论贝那普利联合氢氯噻嗪可良好的控制血压,并能逆转左室重构。     

卡维地洛与拉贝洛尔治疗轻中度高血压病的比较

目的 :评价国产卡维地洛与拉贝洛尔的降压疗效。方法 :轻、中度高血压病病人 2 0 0例 ,采用平行、随机、双盲对照方法 ,其中卡维地洛组 10 0例 ,给卡维地洛 10～ 2 0mg ,po ,bid ;拉贝洛尔组 10 0例给拉贝洛尔 50～ 10 0mg ,po ,bid ;对另 2 0例开放服卡维地洛 ,4 0mg ,po ,qd ;2药均服 4wk。结果 :2药均能明显降压、减慢心率 ;总有效率卡维地洛为 83% ,拉贝洛尔为 75% ,组间比较 (P >0 .0 5)。对 2 0例开放服卡维地洛者 ,治疗前后经 2 4h动态血压监测 ,发现日间平均血压下降及心率减慢差别均有显著意义 (P <0 .0 5或P <0 .0 1) ;对 2 0例中的10例计算血压谷 /峰比值 :SBP为 58% ,DBP为36 %。结论 :2药治疗轻、中度高血压病疗效均较好而安全。     

A comparison of felodipine and propranolol as additions to hydrochlorothiazide in the treatment of hypertension

Summary Eighty one patients with uncomplicated hypertension who required additional antihypertensive medication (diastolic Phase V [dBP]95 mm Hg) after 4 weeks treatment with hydrochlorothiazide (HCTZ) 25 mg o.m. were randomized to receive felodipine 5 mg b.i.d. (n=40) or propranolol (n=41) 80 mg b.i.d. in addition to HCTZ 25 mg o.m. If the dBP measured about 12 h post-dose was not 90 mm Hg after 4 weeks, the dose of felodipine or propranolol was doubled. The double blind trial period was 8 weeks for all patients.Over the 8 week period, felodipine reduced the seated dBP from 100 to 83 mm Hg and propranolol from 101 to 86 mm Hg. The attained seated dBPs were significantly different in the two groups. About one third of patients in each group received the high dose of second-line therapy. After 8 weeks 91% of patients receiving HCTZ+felodipine and 84% receiving HCTZ+propranolol had a dBP 90 mm Hg. Both regimens were well-tolerated with an equal incidence but different pattern of adverse events (felodipine: flushing, headache and peripheral oedema; propranolol: dyspepsia, fatigue and vasospasm).In this 8-week study, felodipine and propranolol were safe and effective second-line antihypertensive drugs when added to hydrochlorothiazide. At the doses selected, felodipine was at least as effective as propranolol.     

A comparative study of the pharmacokinetics and pharmacodynamics of atenolol,hydrochlorothiazide and amiloride in normal young and elderly subjects and elderly hypertensive patients

Summary Six normal young and six normal elderly volunteers and six elderly hypertensive patients took part in an acute and chronic dose study of a combination capsule containing atenolol (50 mg), hydrochlorothiazide (25 mg) and amiloride (2.5 mg) designed for the treatment of hypertension. No difference in any of the drug pharmacokinetic parameters could be detected between the hypertensives and the normal elderly subjects. The bio-availability and the 24-h blood concentrations of all three drugs, half-life of atenolol and amiloride and the peak concentration of hydrochlorothiazide was significantly greater in the elderly. The 24-h blood concentrations of atenolol and hydrochlorothiazide did not alter with chronic dosing, but amiloride concentrations were significantly higher at this time in all groups. A significant fall in the blood pressure was observed in the hypertensive group. Heart rate fell more in the normal and hypertensive elderly subjects than in the young. The combination has shown to be an effective and well tolerated antihypertensive in the elderly patient with a 24-h duration of action.