Chlorthalidone Plus Nicardipine or Atenolol Are Comparable But atenolol + chlorthaHdone Is the better tolerated antihypertensive regimen

40 patients. aged 30-74 years. with mild to moderate essential hypertension randomly received. in single­blind fashion. one of the following for 6 weeks: • atenolol 100mg/chlorthalidone 25mg tablet once daily + 1 placebo capsule tid (n - 22) • chlorthalidone 50mg tablet once daily + nicardipine 30mg capsule tid (n = 18)

Both treatment regimens reduced (p - 0.01) BP and the response to atenolol/chlorthalidone vs nicardipine + chlorthalidone was rated as good. very good or excellent in 16 vs 11 patients. respectively. fair in 2 vs 2 and poor in 3 vs 1. Mean heart rate rose (p = 0.05) in the nicardipine + chlorthalidone group and fell (p = 0.01) in the atenolol/chlorthalidone group.

Five patients were withdrawn from nicardipine + chlorthalidone treatment because of side effects including migraine. swollen ankles. depression. nausea and palpitations. Side effects to atenolol/chlorthalidone vs nicardipine + chlorthalidone affected the cardiovascular (1 vs 6). digestive (4 vs 3). metabolic (0 vs 3). musculoskeletal (0 vs 1). nervous (6 vs 8). and respiratory systems (2 vs 0) and skin (1 vs 0). In the respective groups. side effects were evaluated as very severe (0% vs 18%). severe (5% vs 13%). moderate (10% vs 19%). mild (14% vs 6%). very mild (5% vs 0%) or inconsequential (66% vs 44%). Changes in ECG were more common in the atenolol/chlorthalidone treatment group and significant changes in blood chemistry in this group included a fall in sodium and rises in urea and uric acid levels. Rises in blood glucose and falls in blood potassium. sodium and uric acid levels were recorded after nicardipine + chlorthalidone.

Thus. the 2 active treatments had similar effects on BP but Significantly more side effects were reported with nicardipine + chlorthalidone treatment. DougJas.Jones AP. Ccxhead PF. British Journal of Clinical Practice 40: 1(J().104. Mar 1986

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