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