A multicenter comparison of carvedilol with hydrochlorothiazide in the treatment of mild-to-moderate essential...

The efficacy and safety of carvedilol, a beta-blocker with vasodilatory properties, were compared with that of hydrochlorothiazide (HCTZ) both at a once-daily dose of 25-50 mg in a double-blind, randomized, parallel-group, multicenter study. Following a single-blind placebo phase of 3-6 weeks, 201 eligible patients (aged 27-88 years) were randomized to receive 8 weeks of treatment with either carvedilol or HCTZ, 25 mg doubling to 50 mg at week 4 if the respone was inadequate. Sitting and standing blood pressure and heart rate were recorded 2 h after the first dose and 24 h postdose at weeks 4 and 8. The analysis included 179 patients (11 having withdrawn, including 5 for adverse events, and 11 excluded for protocol violations). There were no statistically or clinically significant differences between treatment groups. Eighty-six percent of patients in the carvedilol group and 88% in the HCTZ group had an 8-week sitting diastolic blood pressure less than or equal to 90 mm Hg or decreased by greater than or equal to 10 mm Hg. Safety profiles were similar for both agents, with a tendency to lower uric acid and total cholesterol levels with carvedilol. Carvedilol and HCTZ at doses compared in this study have similar efficacy and tolerability, with laboratory evidence to suggest a more favorable metabolic profile for carvedilol.