MORE TRIALS IN HYPERTENSION: ~-BLOCKERS AND DIURETICS

Metoprolol looks more effective than alprenolol or oxprenolol 106 patients with previously untreated hypertension, (BP ;) 160 196mm Hg) were randomly treated with metoprolol 1 OOmg bid, alprenolol200mg bid or oxprenolol 80mg bid for 4 weeks, followed by 8 weeks treatment at double-dose. During the next 38 weeks they were maintained on the lowest dose which gave a BP of < 160/95mm Hg, and if this could not be achieved they were given hydrochlorothiazide 12.Smg bid as well. Metoprolol gave the greatest reduction in BP at both the low and high dose levels, and by 12 weeks' treatment, the greatest reduction in heart rate. The BP of 20 patients receiving metoprolol was adequately controlled for 12 months with lower doses (200-400mg daily) than alprenolol and only 1 patient required hydrochlorothiazide compared with 8 patients receiving alprenolol and 14 on oxprenolol. Monotherapy with metoprolol was adequate in 95 % of patients, but alprenolol and oxprenolol alone were only successful in 68 % and 46 % of patients respectively. There were few side effects: I patient on metoprolol withdrew due to insomnia and I on alprenolol due to dizziness and tiredness. Serum cholesterol decreased and bilirubin increased in patients receiving metoprolol and oxprenolol and there was a reduction in uric acid levels in the oxprenolol and alprenolol groups where hydrochlorothiazide treatment was more commonly required. Tuomilehto, J.: Acta MCldica Scandinavica (Supp1. 625}. 74 (1979)

And is effective in fixed combination with hydrochlorothiazide A single preparation containing I OOmg metoprolol and 12.Smg hydrochlorothiazide was given daily to 12 women and bid to 2 others. The women had remained hypertensive on ~-blocker monotherapy for 2-8 years but on the combination there was a significant reduction in systolic and diastolic pressures. In 5 of the women 200mg metoprolol daily had not by itself controlled hypertension, but combination therapy allowed reduction of the metoprolol to I OOmg daily. Two women reported increased sweating which disappeared when they reverted to their former therapy, but the other 10 continued for more than I year with no side effects and negligible changes in serum potassium and uric acid levels. Bengtsson. C.: Current Therapeutic Research 26: 394 (Sep 1979)

Another fixed combination: frusemide plus slow release K is as good as separate components i 0 middle-aged and eidecly patients. whose hypertension had been maintained on frusemide (furosemide, 'Lasix'; Hoechst) and separate potassium supplementation ('Slow-K'; Ciba) were changed to a single preparation containing 40mg frusemide and 600mg potassium chloride in a slow-release formulation ('Diumide-K Continus'; Napp Laboratories). No change in blood pressure was observed and plasma K levels were satisfactorily maintained within normal limits during treatment with the combination. Lewis, J.G.: Journal oflnternational Medical Research 7: 354 (No 5, 1979)

12 INPHARMA 27 Oct 1979 0156-2703/79/1027-0012 $0 .50/0 ©ADIS Press