Source: Lancet | Posted 11 years ago
Ace inhibitors, beta-blockers, calcium blockers, and diuretics for the control of systolic hypertension
Tags:
Initial treatment of elderly people with essential hypertension should consist of thiazide diuretics or calcium-antagonists.
These are more effective than other agents at lowering systolic blood pressure, say researchers based at the Department of Physiology, University of Melbourne, Victoria, Australia.
Beta-blockers are relatively ineffective, are often contraindicated and have more side effects, the investigators conclude from a randomised study. Monotherapy seldom achieves blood pressure control, for which combination therapy is usually needed.
The study sought to determine, first, which common group of antihypertensive drugs is most effective at lowering systolic blood pressure in elderly patients with previously untreated hypertension and, secondly, the percentage of patients controlled with single or sequential monotherapy.
The study, of a balanced, crossover design, recruited 74 out-patients with systolic blood pressure greater than 150 mm Hg after three visits. For one month, patients were given either placebo or a low and high dose of each of four main classes of drugs - angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, calcium antagonists and diuretics.
Blood pressure was measured 24 to 26 hours after the previous dose. A questionnaire for side effects was completed at each visit.
Beta-blockers could not be used in 15 patients because of asthma or bronchospasm. These patients had two placebo periods.
Nine of 66 patients on placebo, nine of 46 on beta-blockers, four of 65 on calcium antagonists, four of 65 on diuretics and one of 62 on ACE inhibitors did not progress to the higher dose because of side effects.
When corrected for placebo, six to 15 percent of patients on monotherapy reached the target systolic blood pressure of 140 mm Hg or less. Sequential monotherapy achieved target in 29 percent.
Patients on ACE inhibitors, calcium antagonists and diuretics had no more side effects than placebo but patients on beta-blockers did, and their well-being scores were reduced.
Comments