Captopril and atenolol combined with hydrochlorothiazide in essential hypertension.

Abstract

1 Fifty-seven patients with mild or moderate essential hypertension, mean age 50 (range 31-69) were randomised to treatment with either captopril or atenolol. Twenty-six patients in each group completed the study. 2 Captopril (25-50 mg three times daily) and atenolol (50-100 mg once daily) caused a highly significant fall in blood pressure both supine and standing. 3 When hydrochlorothiazide (25-50 mg once daily) was added a further fall in blood pressure was observed in both groups. 4 Captopril as single drug caused no significant change in heart rate, while atenolol significantly reduced heart rate both supine and standing. 5 Two patients were excluded from the captopril group, one because of a reversible loss of taste and the other because of dizziness. Three patients were excluded from the atenolol group, two because of bradyarrhythmias and one because of inadequate blood pressure response. 6 Both captopril and atenolol were found to be effective antihypertensive agents, suitable for the treatment of essential hypertension.

Comparison of quinapril and atenolol as single drugs or in combination with hydrochlorothiazide in moderate to severe hypertensives, using automated ambulatory monitoring.

“…This double-blind study compared the effects of quinapril, a new ACE inhibitor, and atenolol as single drugs or combined with hydrochlorothiazide in moderate to severe hypertensives in whom blood pressure was documented by ambulatory monitoring. Our data extend previous findings (Andren et al, 1982;Goldstein, 1990) and demonstrate that both the ACE inhibitor and the ,Badrenoceptor blocker provide comparable efficacy on conventional blood pressure in treatment of moderate to severe hypertension when used as initial monotherapy and with addition of hydrochlorothiazide. Moreover the addition of the diuretic increases the proportion of patients reaching clinical response in both groups but more so in the quinapril group.…”

“…Angiotensin-converting enzyme (ACE) inhibitors and P-adrenoceptor blockers effectively reduce bloodpressure in patients with moderate to severe hypertension either as first-line monotherapies or when given concomitantly with a diuretic (Andren et al, 1982;Bateman et al, 1979;Frishman & Greenberg, 1991; Goldstein, 1990;Lacourci6re et al, 1991). However, there are presently no data comparing the antihypertensive effects of ACE inhibitors with those of 3-adrenoceptor blockers alone or in combination with thiazide diuretics on ambulatory blood pressure in moderate to severe hypertensives.…”

“…The incidence of side effects was similar during the treatment with either quinapril (n = 11) or atenolol (n = 11). One subject experienced severe Raynaud's phenomenon during treatment with atenolol that resolved completely (Andren et al, 1982;Goldstein, 1990) Weber, 1988). By providing a substantial number of blood pressure values, this technique decreases withinsubject variation and greatly increases the power of blood pressure measurements (Coats et al, 1992 (Graettinger et al, 1989 (Lacourciere et al, 1990;Pickering et al, 1989).…”

Captopril for Refractory Hypertension in Patients with Impaired Renal Function

“…Many recent studies suggest that a diuretic is a valuable adjunct during captopril therapy. Some studies suggest that once a basic treatment level of 25 mg (three times daily) of the drug has been attained, blood pressure control can be improved by either adding-in or increasing the dose of diuretic rather than augmenting captopril dosage (Brunner et al 1979, Ferguson et al 1980, Case et al 1982, McGregor et al 1979, Veterans Administration Co-operative Study Group 1982, Atkinson et al 1980a, Andren et al 1982, Santucci et al 1982. This manoeuvre was not attempted in our series but may have allowed a reduction in our higher mean daily dose.…”

Pharmacokinetics and biological effects of captopril and hydrochlorothiazide after acute and chronic administration either alone or in combination in hypertensive patients.

“…In a large number of clinical trials, the combination of captopril with hydrochlorothiazide (HCTZ) has been shown to be highly effective in the treatment of essential hypertension, resulting in a satisfactory control of blood pressure in about 80% of the patients vs 50% with captopril alone and approximately 60% with HCTZ alone (Veterans Administration Cooperative Study Group, 1982a,b;Andren et al, 1982;MacGregor etal., 1982;Weinberger, 1982Weinberger, , 1985Costa etal., 1985;Lederle, 1985). Moreover, it has been demonstrated that this combination might be of particular interest in long term treatment since some of the unwanted metabolic effects of chronic thiazides administration may be partially prevented by captopril (Weinberger, 1982(Weinberger, , 1985Costa et al, 1985).…”