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Comparison of hydrochlorothiazide and atenolol as initial treatment in uncomplicated hypertension
Insights
Atenolol, a beta-blocker, showed superior short-term efficacy over hydrochlorothiazide in treating hypertension. Both drugs reduced patient complaints, but atenolol achieved better blood pressure control in this study.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension is a prevalent condition requiring effective treatment.
- Assessing the comparative efficacy of different antihypertensive medications is crucial for patient management.
Purpose of the Study:
- To compare the short-term efficacy of atenolol and hydrochlorothiazide in treating uncomplicated hypertension.
- To evaluate treatment outcomes, including blood pressure reduction and patient-reported complaints.
Main Methods:
- A randomized controlled trial involving 119 hypertensive patients.
- Patients received either hydrochlorothiazide or atenolol, with subsequent medication switches for non-responders.
- Blood pressure and patient complaints were monitored over 6 months.
Main Results:
- Atenolol achieved significantly better diastolic pressure reduction compared to hydrochlorothiazide within one month (p < 0.001).
- Switching non-responders to the alternative medication showed similar efficacy patterns.
- Both drugs reduced patient complaints, with no significant difference between them.
Conclusions:
- Atenolol demonstrates superior short-term efficacy compared to hydrochlorothiazide for uncomplicated hypertension.
- Both medications offer symptomatic relief, but atenolol provides more effective blood pressure control initially.
- Combination therapy and dose adjustments were effective for some non-responders.
Abstract:
After screening a local population in the northern part of The Netherlands for hypertension, 119 patients with a diastolic pressure (DP) between 95 and 120 mmHg were randomised and treated either with 50 mg hydrochlorothiazide (n = 59) or 100 mg atenolol (n = 60). After 1 month of treatment 6 patients in the hydrochlorothiazide group and 24 patients in the atenolol group had reached a DP less than or equal to 90 mmHg (p less than 0.001). 43 of the 50 non-responders to hydrochlorothiazide were switched to atenolol and 30 of the 35 non-responders to atenolol were changed to hydrochlorothiazide. One month after the switch 19 patients in the atenolol group and 2 patients in the hydrochlorothiazide group had reached a DP less than or equal to 90 mmHg (p less than 0.001). After 6 months of treatment 32 of the 43 atenolol responders and 7 of the 8 hydrochlorothiazide responders were still receiving the same medication, as their DP was still less than or equal to 90 mmHg. Non-responders to either medication were given the combination (n = 46). 21 patients now became normotensive as did a further 10 after increasing the dose of atenolol to 200 mg. Thus, in all 70 patients had a blood pressure less than or equal to 90 mmHg after treatment for 4 months. Both drugs induced a significant reduction in the total of number of complaints after 1 month of treatment. They did not differ from each other. The reduction was seen both in responders and non-responders and persisted during treatment for 6 months. It is concluded that in terms of short-term efficacy the cardioselective, hydrophilic beta adrenoceptor-blocking drug atenolol is preferable to hydrochlorothiazide in the treatment of uncomplicated hypertension.