Bendroflumethiazide + Propranolol is More Effective than Monotherapy And the combination in a single capsule may improve compliance in hypertensive patients

A multicentre double-blind crossover study was designed to evaluate the hypertensive efficacy of bendroflumethiazide [bendrofluazide], propranolol and a combination of the 2 agents. 25 evaluable patients with essential hypertension (supine BP > 160/90mm Hg after a 2-week placebo run-in) randomly received bendroflumethiazide Smg once daily, long-acting propranolol ('lnderal LA') 160mg once daily and a fixed combination of both as one capsule ('lnderex') once daily for 4 weeks each. All other antihypertensive medication was withdrawn.

A significant fall in BP was observed for all 3 treatments in standing and lying positions and after exercise. Combination treatment was significantly more effective in reducing systolic BP when standing, lying and after exercise than bendroflumethiazide, and in decreasing systolic pressure when standing and after exercise than propranolol. Diastolic BP was lower after treatments containing propranolol compared with bendroflumethiazide alone (not significant). Propranolol treatments reduced HR significantly more than bendroflumethiazide.

Bendroflumethiazide alone decreased plasma potassium concentrations significantly more than propranolol monotherapy or combination treatment. Bendroflumethiazide, alone and in combination with propranolol, significantly raised plasma urate levels compared with propranolol alone. The frequency of adverse effects was similar for the 3 groups. Two patients withdrew because of side effects, 1 on combination therapy (sweating and leg weakness) and 1 on bendroflumethiazide (headaches, vertigo and lethargy).

The authors concluded that the overall effect of combination treatment ' ... was greater than following l'hdividual administration of the component drugs, and the treatment was well tolerated'. Crowe PF, Fmnegan OC, Russell CJMcL, Varma MPS British Journal of Clin1cal Practice 41 967-970, Oct 1987

0156-2703/87/1219-0005/0$01.00/0 © ADIS Press INPHARMA® 19 December 1987 5