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Differential exercise effects of captopril and nadolol in patients with essential hypertension
J B Kostis1, D M Shindler, A E Moreyra
1Division of Cardiovascular Diseases & Hypertension, UMDNJ-Robert Wood Johnson Medical School, New Brunswick.
Insights
Captopril and nadolol effectively lower blood pressure in hypertensive patients. Nadolol demonstrated a more significant reduction in systolic blood pressure during exercise and lowered heart rate more than captopril.
Area of Science:
- Cardiology
- Pharmacology
- Exercise Physiology
Background:
- Hypertension management requires effective therapeutic strategies.
- Understanding the differential effects of antihypertensive drugs during rest and exercise is crucial for patient care.
Purpose of the Study:
- To compare the effects of captopril and nadolol on blood pressure and heart rate at rest and during exercise in patients with mild to moderate hypertension.
- To investigate potential differences in the mechanisms of action of these drugs under varying physiological conditions.
Main Methods:
- A crossover study involving 12 patients with mild to moderate hypertension.
- Patients received placebo, captopril (12.5-50 mg TID), and nadolol (20-160 mg QD) in a randomized sequence.
- Blood pressure and heart rate were measured at rest and during graded exercise (up to 9.0 METS).
Main Results:
- Both captopril and nadolol significantly reduced resting diastolic blood pressure to a similar degree.
- Both drugs lowered systolic and diastolic blood pressure at rest and during exercise.
- Nadolol exhibited a more pronounced reduction in systolic blood pressure during exercise compared to captopril.
- Nadolol significantly decreased heart rate at rest and during exercise compared to both placebo and captopril.
Conclusions:
- Captopril and nadolol are effective in controlling hypertension.
- Nadolol demonstrates superior efficacy in reducing systolic blood pressure during exercise and lowering heart rate.
- The findings suggest distinct pharmacological actions of captopril and nadolol at rest and during physical activity, informing therapeutic selection for specific patient groups.
Abstract:
In a crossover study, 12 patients with mild to moderate hypertension were given placebo, captopril (12.5 to 50 mg three times a day), and nadolol (20 to 160 mg once a day) to control the resting diastolic blood pressure to a nearly identical degree (p less than 0.0001) (106.1 +/- 4 placebo, 89.6 +/- 8 captopril, 89.8 +/- 7 nadolol). Both drugs lowered (p less than 0.0004) systolic and diastolic blood pressure at rest and during exercise. However, systolic blood pressure lowering during exercise was more pronounced (p less than 0.05) with nadolol than with captopril (difference of 6 mmHg, 16 mmHg, and 21 mmHg at 5.0, 7.0, and 9.0 metabolic equivalents (METS) respectively). Heart rate was lower (p less than 0.05) at rest and during exercise with nadolol as compared with placebo and with captopril. These data imply different mechanisms of action of the two drugs at rest and during exercise and may help in selection of drug therapy in special patient subsets.