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 ' ... 10·20mg of blsoprolol had a significantly greater antihypertensive effect than 50·100mg 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
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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 drugrelated 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
