Alternative Antihypertensive Agents to Atenolol?

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  • Alternative Antihypertensive Agents to Atenolol? Once daily bisoprolol controls BP more effectively than atenolol ....

    A randomised double-blind trial was conducted to evaluate the efficacy, tolerability and pharmacokinetics of bisoprolol in the treatment of patients with mild to moderate essential hypertension (diastolic BP of 90-120mm Hg). Following a 4-to 6-week placebo run-in, 17 evaluable patients received either oral bisoprolol 10mg once daily or oral atenolol 50mg once daily for 6 weeks. Drug dosages were doubled after 2 weeks if sitting diastolic BP was~ 90mm Hg or had not been reduced by 10mm Hg. After a 2 week washout period, patients crossed over to the alternate treatment for a further 6 weeks.

    Mean sitting BP was reduced from 168/103mm Hg to 146/88mm Hg and to 150/94mm Hg following 6 weeks treatment with bisoprolol and atenolol, respectively. Bisoprolol reduced standing diastolic and sitting and standing systolic BPs significantly more than atenolol. Mean HR was reduced with bisoprolol by 17 beats/min and atenolol by 18 beats/min. Median elimination half-lives were 11.2 hours and 6.4 hours for bisoprolol and atenolol, respectively. The median clearance was reduced from 264 and 333 ml/ min after a single dose to 212 and 289 mljmin after chronic dosing of bisoprolol and atenolol, respectively. Glutamyl transferase activity was increased (from 39 to 114 IU) in 1 patient receiving bisoprolol. There were no other reported biochemical or haematogical changes.

    The authors concluded that 'bisoprolol is an effective and a well tolerated antihypertensive agent ... ' and that ' ... 1020mg of blsoprolol had a significantly greater antihypertensive effect than 50100mg of atenolol'. Lewis R, Maclean D. loannides C, Johnston A, McDevitt DG. British Journal of Clinical Pharmacology 26. 53-59. Jul 1988

    ... but controlled release verapamil is as effective as atenolol in reducing BP


    The antihypertensive effects and tolerability of controlled release verapamil and atenolol were compared in patients with mild to moderate essential hypertension (sitting diastolic BP of 95-115mm Hg) in a double-blind study. After a 4-week placebo run-in, 104 general practice patients received either controlled release verapamil 240mg once daily (n = 51) or atenolol 50mg once daily (53) for 16 weeks. The drug dosages were doubled after 4 weeks and hydrochlorothiazide 25mg added after 8 weeks, if necessary, to achieve a reduction in diastolic BP to~ 90mm Hg or by~ 15mm Hg (goal BP).

    Mean BP was reduced by 23/21 mm Hg in verapamil recipients and by 24/20mm Hg in atenolol recipients after 16 weeks' treatment. Goal BP was achieved by 39/51 verapamil recipients and 39/53 atenolol recipients after 4 weeks and by 43/45 and 41/46 patients, respectively, after 16 weeks of therapy. Heart rate was reduced more in atenolol than verapamil recipients (p < 0.05). The most common adverse effects were constipation, dizziness and rash in verapamil recipients and tiredness and dizziness in atenolol recipients. Four verapamil and 7 atenolol recipients withdrew because of drug-related adverse effects.

    Thus, controlled release verapamil should ' ... be considered as a rational alternative first line drug for the treatment of hypertension in general practice'. Henry JA. Chester PC. Latham AN Journal of Drug Development 1 69-75. Jul 1988 , ...

    0156-2703/88/1015.0009/0$01.00/0 ADIS Press INPHARMA 8 15 Oct 1988 9


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