Enalapril has a Greater Antihypertensive Effect than Atenolol In the short term and quality of life is slightly better with enalapril

Although beta blockers have established antihypertensive efficacy, there is concern that adverse effects on lung function, mental activity and quality of life render beta blocker therapy less than optimal. ACE inhibitors may have superior antihypertensive efficacy to beta blockers with fewer adverse effects, so a 3-centre randomised double-blind study was conducted to assess this hypothesis. Patients with a supine BP of 140-220/90-119mm Hg after a 4-week placebo run-in received either enalapril 20mg (n = 86) or atenolol 50mg (76) daily for 12 weeks; dosages were doubled after 4 or 8 weeks if BP was not reduced to ::::; 140/90mm Hg.

Enalapril therapy decreased supine and standing BP to a greater extent than atenolol therapy, with 35 and 12"/o of patients, respectively, achieving goal BP. Further, enalapril had significantly greater beneficial effects on attention and mental speed than atenolol and did not attenuate pressor responses to exercise, as did atenolol. Lung function, exercise duration and frequency of adverse effects did not differ between treatment groups after therapy, although body weight and serum uric acid were both significantly greater after atenolol therapy than enalapril therapy.

The authors concluded that enalapril 20-40mg had greater antihypertensive efficacy than atenolol 50-1 OOmg in the short term, and that 'measurements of quality of life also tended to favour enalapril, but the differences were small and the overall tolerability of the two drugs was similar'. Herrtck AL. Waller PC. Berk1n KE, Pnngle SO. Callender JS. et al Comparison of enalapnl and atenolol 1n mild to moderate hypertens1on Amencan Journal of Med1c1ne 86· 421-426, Apr 1989 ""'

12 INPHARMA'" 13 May 1989 0156-2703/89/0513-0012/0$01.00/0 © AD/S Press