ATENOlOllN HYPERTENSION: A SYMPOSIUM

In a Symposium held by Stuart Pharmaceuticals at the Royal Society of Medicine, 25-26 January 1977, aspects of the treatment of hypertension, with particular reference to atenolol, were discussed. Atenolol is a cardioselective beta-blocking drug which has no membrane stabilising or partial agonist activity. In tests of its relative cardioselectivity in 14 patients with asthma, a single dose of I OOmg of atenolol produc;ed less bronchoconstriction than propranolol I OOmg, pindolol 5 mg or acebutolol 300mg. Both atenolol and acebutolol permitted a bronchodilator response to inhaled isoprenaline (isoproterenol) but propranolol and pindolol blocked such a response. In dose-finding studies in hypertensive patients, I OOmg given once daily appeared to provide good control of blood pressure, similar to that achieved with multiple daily doses, along with a low incidence of adverse effects.

o Compared with Placebo when Added to Existing Regimens In a double-blind crossover study in 51 patients with hypertenSion, atenolol I OOmg once daily or a placebo were added to existing antihypertensive regimens for 4 weeks each, followed by atenolol administered to all patients for 8 weeks. The mean initial blood pressure was 180/ I 07mm Hg. After 4 weeks with a placebo added to the existing treatment this fell to 171/ I OOmm Hg, while the corresponding value with atenolol was 161/91 mm Hg (a significant difference compared with placebo; p < 0.00 I). While a placebo had no effect on heart rate, atenolol produced a mean decrease of 12 beats per minute. Some minor side-effects occurred with atenolol, but the incidence was not statistically greater than with a placebo. 'It is therefore concluded that, where inadequately controlled hypertensives are under consideration, the addition of 100mg of atenolol once a day is a logical next step.'

et al. L'Ouest Medical 30: 809 (( 917) On the prevalence, diagnosis and management of lithium-induced

hypothyroidism in psychiatric patients. Lindstedt, G. et al. British Journal of Psychiatry 130: 452 (917)

Lithium-induced 'primary' hyperparathyroidism. Christiansen, C. et al. Calcified Tissue Research 22: 341 (1977)

And others Manifestations cutanees provoquees par Ie lithium (cutaneous side-effects of

treatment with lithium). Reiffers, J. et al. Dermatologica 155: 155 (J 977) Lithium acne. Okrasinksi, H. Dermatologica 154: 251 (/977) Lithil1m ~Its: therapeutic and unwanted effects. Ghose, K. British Journal of

Hospital Medicine 18: 578 (J 977) Lithium-intoxication masked by neuroleptic drugs in lithium-saluretic

combination. Lenz, G. et al. Der Nervenarzt 48: 630 (1977) Adverse effects of lithium treatment. British Medical Journal 2: 346 (1977)

Adverse effects of lithium treatment. West, A. British Medical Journal 2: 642 (1977)

Lithium intoxication. Zarifian, E. et al. La Revue du Praticien 27: 2257 ([ 977) Memory loss with lithium? Bajor, G.F. American Murnal of Psychiatry 134:

588 ([ 977) Delirium associated with lithium therapy and electroconvulsive therapy.

Hoenig, J. et aI. Canadian Medical Association Journal 116: 837 (t 977)

Exacerbation of psoriasis during lithium treatment Skott, A . et at. British Journal of Dermatology 96: 445 (1977)

Acute lithium toxiCity and its physiological correlates. Elizur, A. et al. Harefuah 92: 248 (1977)

Comparison of side effects with coated lithium carbonate tablets and lithium preparations giving medium-slow and slow-release. A double-blind crossover study. Edstrom, A. et al. Acta Psychiatrica Scandinavica 55: 153 (J 977)

Frusemide and lithium toxicity . Oh, T.E. Anaesthesia and Intensive Care 5: 60 (1977)

Side effects and therapeutic accidents induced by lithium salts. Sutter, J .M. et al. La Revue de Medecine 18: 153 (1977)

Lithium side effects in relation to dose and to levels and gradients of lithium in plasma. Persson, G. Acta Psychiatrica Scandinavica 55 : 208 (t 977)

Lithium-induced granulocytosis. Tisman, G. et al. Lancet 2: 25 I (1977) Severe lithium toxicity with 'normal' serum concentrations. Speirs, J. et at.

British MedicalJournal I: 815 ([ 978)

Heat illness syndrome and lithium intoxication. Granoff, A.L. et at. Journal of Clinical Psychiatry 39: 103 {I 978)

Lithium and memory impairment. Coppen, A. et aI. Lancet I: 448 (1978)

o Drug interactions Lithium and chlorpromazine (CPZ) interaction. Kerzner, B. et aI. Clinical

Pharmacology and Therapeutics 19: 109 (\ 976) Potentiation of succinylcholine neuromuscular blockade by lithium carbonate.

Hill, G .E. et al. Anesthesiology 44: 439 ([ 976) Adverse interaction of lithium carbonate and methyldopa. O'Regan, J.B.

Canadian Medical Association Journal! ! 5: 385 (J 97(,) ~

Effect of lithium on gastric emptying and absorption of oral chlo).promazine. Rivera-Calimlim. L. Psychopharmacology Communications 2: 263 (! 976)

Effect of chlorothiazide on the pharmacokinc:tics of lithium in plasma and erythrocytes. Pouest, R.I. et at. Psychopharmacology Communications 2: 273(1976)

Cocaine, amphetamine and lithium interactions: neurobiological correlates. Mandell, AJ. et al. Annals of the New York Academy of Sciences 281 : 441 (1976)

Frusemide and lithium toxiCity. Oh, T.E. Anaesthesia and Intensive Care 5: 60 (1977)

Haloperidol attenuation of morphine abstinence synergistic effect of acute lithium administration. Bromfield, H. et al. Journal of Pharmacy and Pharmacology 29: 238 {I 977)

Adjustment of lithium dose during lithium-chlorothiazide therapy. Himmelhoch, J.M. et at. Clinical Pharmacology and Therapeutics 22: 225 (1977)

Lethal effects of physostigmine plus lithium in rats. Samples. J.R. et aI. Psycho-pharmacology 52: 307 (\ 977)

Potentiation of d-tubocurarine (d-Te) neuromuscular blockade in cats by lithium chloride. Basuray, B. N. et at. European Journal of Pharmacology 45: 79 ([ 977)

Effect of lithium on plasma chlorpromazine levels. Rivera-Calirnlim, L. et al. Clinical Pharmacology and Therapeutics 23: 451 (1978)

Lithium-pancuronium interation. Jefferson, J.W. Annals oflnternal Medicine 88: 577 ([ 978)

Interaction of lithium and bicarbonate. McSwiggan, C. Medical Journal of Australia I: 38 (1978)

INPHARMA 13th May, 1978 p17