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Multiclinic controlled trial of bethanidine and guanethidine in severe hypertension
Insights
Guanethidine demonstrated superior efficacy in lowering diastolic blood pressure compared to bethanidine in patients with hypertension. This study found guanethidine achieved better blood pressure control and fewer adverse effects than bethanidine.
Area of Science:
- Pharmacology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Hypertension management often requires combination therapy.
- Hydrochlorothiazide is a common diuretic for hypertension.
- Adrenergic blocking agents are used to augment antihypertensive therapy.
Purpose of the Study:
- To compare the efficacy and side effects of guanethidine and bethanidine as add-on therapy to hydrochlorothiazide.
- To evaluate the effectiveness of shorter-acting (bethanidine) versus longer-acting (guanethidine) antihypertensive agents.
Main Methods:
- A randomized, double-blind study involving 108 hypertensive patients.
- Patients received hydrochlorothiazide plus either bethanidine or guanethidine.
- Diastolic blood pressure was monitored over several months.
Main Results:
- Guanethidine resulted in a greater average reduction in diastolic blood pressure (18.4 mm Hg) compared to bethanidine (13.6 mm Hg).
- A significantly higher percentage of patients on guanethidine achieved target diastolic blood pressure (<90 mm Hg) (68.8% vs. 45.5%).
- Bethanidine showed a greater degree of orthostatic fall in blood pressure.
Conclusions:
- Guanethidine is significantly more effective than bethanidine in controlling hypertension when added to hydrochlorothiazide.
- The study did not support the hypothesis that shorter drug action provides better blood pressure control.
- Guanethidine appears to be a more favorable treatment option in this hypertensive patient cohort.
Abstract:
One hundred and eight patients with initial diastolic blood pressure in the range of 100-124 mm Hg while taking hydrochlorothiazide were assigned randomly and double-blind to hydrochlorothiazide plus either bethanidine or guanethidine. The average reduction of the fifth and sixth months' diastolic blood pressure was 18.4 mm Hg for guanethidine and 13.6 mm Hg for bethanidine (P less than 0.01). The distribution of the individual values was such that 68.8% of guanethidine treated patients achieved a diastolic level below 90 mm Hg, compared to only 45.5% of the bethanidine treated group (P less than 0.025). The degree of orthostatic fall in blood pressure was greater with bethanidine than with guanethidine (P less than 0.05). The diurnal variation of blood pressure was slightly greater with bethanidine than with guanethidine. The results significantly favor guanethidine. This study failed to demonstrate that the shorter action of bethanidine confers significantly better control of blood pressure than the longer action of guanethidine.