Hypertension: Short Communications 70

Table If. Incidence of unwanted symptoms after 2 weeks of placebo run-in and after 2 and 4 weeks of atenolol

After placebo After 2 weeks on atenolol After 4 weeks on atenolol

BTS

TES

Total 671

303

201

504

S 287 = or) l16 t 191

148

339

S 179 = or * ? 12 t

BTS = Symptoms already present before atenolol treatment; symptoms remained either unchanged (=) or decreased or dis­appeared W or worsened (!) during atenolol treatment.

TES = Symptoms emerged during atenolol treatment.

shows all the possible ED values that can be ob­tained subtracting the negative effect score from the positive score. ED = 3 (outlined in the ED ma­trix) is the maximum positive ED (EDmax); it is obtained in the best situation when the positive effect is score 3 (marked) and negative effect is score o (absent). The OAI is the ratio of the sums of all EDs obtained in the 'n' visits of the trial to (n) times EDmax (the denominator is the maximum positive value that ED sums could reach for that trial).

Results: Compared with placebo run-in, after 2 weeks and 4 weeks treatment with atenolol 100 mgj day, there was a consistent and significant (p < 0.00 1) reduction in supine and standing systolic and diastolic BP and heart rate (table I). Only 3 patients withdrew because of side effects. The elicited USS were vastly over-reported and only those symp­toms already present before atenolol treatment whose severity increased during active treatment (5.3% at 2 weeks; 6.3% at 4 weeks) were included in the analysis (table II). The response to atenolol was good to excellent in 233 patients (73%), whereas a poor to bad response was recorded for 88 patients (27%) (table III).

Discussion: The clinically and statistically sig­nificant fall in blood pressure observed in this study confirms the antihypertensive effect of atenolol re-

Table III. Classification of patients' response according to overall assessment index (OAI)

Classitication of response No. of % patients

Excellent 157 49 t (73)

Good 76 24

Poor 41 13 t (27)

Bad 47 15

ported by other workers. The response of atenolol­treated patients based on OAI is satisfactory (ex­cellent and good) in 73%, confirming that atenolol may successfully be used in treatment of hyperten­sion.

Atenolol Once Daily in Essential Hypertension A Multicentre Study

C.L. Alicandri, E. Agabiti-Rosei, B. Cerri, L. Corea, P. Innocenti, G. Levi, F. Mantero, C. Porcel/ati, E. Solinas, M. Toso, C. Vaori, O. Visioli and G. Muiesan Clinica Medica V, University of Milan, Spedali Civili, Eulo, Brescia, Italy

In a multi centre open study, 188 essential hypertensive patients (WHO stage I-II), age 19 to 69 years (mean 47 ± 0.8), were treated with at­enolol lOOmg, given in a single dose in the morn­ing. They were untreated or had all other anti­hypertensive medications discontinued 2 weeks before placebo was given for 2 additional weeks. Atenolol treatment was started after the 2 weeks of placebo. Systolic and diastolic blood pressures and heart rate were measured lying and standing at the beginning and the end of the placebo period and at 0.5, 1, 3 (90 patients) and 6 months (26 patients) of treatment with atenolol 100mg once daily.

!f E E

Hypertension: Short Communications

Placebo

90

60

50

, , Atenolol '00 mg Once Dally

(18811 188)

, -0.5 -Run- tn

i ,

0.5 1.0 1

3.0

Month

Fig. 1. Supine and standing heart rate.

PlacebO J , A1 enOIOI 100 mg Once Daily

180 (188)(188)

160

140

120

100

• Supine

• Standing ••• 0 <:0.001

( t No. patients

, 6.0

[1 Systolic BP

• Diaslolic BP ••• 0<:0.001

( ) No. patients

~ ---_.=------..........

a

80

, -0.5 -Run-In

Placebo

i i 0.5 1.0

, 3.0

Month

, , Atenoloi 100 mg Once Daily

180 1188)(188)

160 1183)

01 140 :I:

~ 120

. .. (182) 190)

6'0

(1 Systotic BP

• Diastolic 8P

ou p<O.OOI

I ) No . patients

l00~ ----iiC·e:. .. _ ________ ....

b

80

, -0.5 -Run-In

0'5 ,'0 6'0

Month

Fig. 2. Supine (a) and standing (b) blood pressure.

71

Results: Compared with baseline placebo lev­els, atenolol 100mg once daily caused significant reductions (p < 0.001) over the period 0.5 to 6.0 months in supine and standing heart rate (fig. I), and supine and standing systolic and diastolic blood pressures (figs. 2a and b). A highly significant re­duction (p < 0.001) of heart rate and blood pres­sure (both SBP and DBP supine and standing) was also present when the 90 patients at the end of 3 months and the 26 patients at the end of 6 months of atenolol treatment were compared with them­selves at the end of placebo period (paired t-test). Blood chemistry, ECG and bodyweight were un­changed throughout the treatment period. Treat­ment was discontinued in 18 patients owing to a low efficacy and in 5 because of side effects.

This study confirms previous reports (de Tol­lenaere and Verdack, 1976; Marshall et aI., 1977) of a satisfactory blood pressure reduction during atenolol 100mg once daily in essential hyperten­sive patients.

References

de Tollenaere, G. and Verdack, G.: Acta Therapeutica I: 317 (1976).

Marshall, A.J. et al.: Postgraduate Medical Journal 53 (Suppl. 3): 168 (1977).

Atenolol in Orally Treated Diabetic Patients

L. Hausmann and K.M. Goebel Department of Medicine. University of Marburg. West Germany

Before prescribing ~-blockers for diabetic patients, a warning must always be given that their use can mask early hypoglycaemic symptoms such as tachycardia and sweating (Wolf, 1977). Numer­ous investigations have also shown that, with the use of ,a-blockers, blood sugar rises more slowly in diabetics as well as in metabolically healthy people after an inSulirt~induced hypoglycaemia (Lager et aI., 1979), but this phenomenon is less apparent