Comparison of acebutolol and hydrochlorothiazide in essential hypertension

In a multicenter, double-blind comparison of acebutolol and hydrochlorothiazide in patients with mild to moderate essential hypertension (diastolic blood pressure, 95 to 114 mm Hg) in 182 and 178 patients, respectively, each agent reduced systolic and diastolic pressures to a similar significant degree: acebutolol, 15.9 and 14.9 mm Hg; hydrochlorothiazide, 15.2 and 13.3 mm Hg (p less than 0.001 vs baseline). Acebutolol significantly reduced heart rate by 8.9 bpm at the end of dose titration (p = 0.001), with no further decrease seen during maintenance. Fourteen patients on each treatment regimen were discontinued from the study because of side effects. However, significantly more hydrochlorothiazide patients experienced side effects of arrhythmia, anorexia, and flatulence; in addition, more hydrochlorothiazide patients developed abnormal levels of serum glucose, uric acid, blood urea nitrogen, serum potassium, and chloride. In a single-center study of patients who remained hypertensive while receiving diuretics, six of nine patients receiving acebutolol concomitantly with a diuretic responded (seated diastolic blood pressure reduced below 90 mm Hg), whereas no patients receiving placebo and diuretic concomitantly responded (p less than 0.01). Patients taking both acebutolol and diuretic had significant reductions in diastolic blood pressure (11 mm Hg) and heart rate (16 bpm) compared with those taking diuretic alone (p less than 0.05, less than 0.01) and those taking both placebo and diuretic (p less than 0.05). No significant side effects were noted. Acebutolol is as effective as hydrochlorothiazide as monotherapy for mild to moderate essential hypertension and, in addition, is effective when added to a diuretic in patients who remain hypertensive while taking diuretics.(ABSTRACT TRUNCATED AT 250 WORDS)