Combined α/β-blockade versus β1-selective blockade in essential hypertension in black and white patients

Abstract

The purpose of this multicenter investigation was to determine the efficacy and safety of the alpha/beta-blocker labetalol versus the beta 1-selective beta-blocker atenolol in white and black patients with essential hypertension. Equal numbers of black and white patients were enlisted to form four treatment groups (white patients taking either labetalol or atenolol and black patients taking either labetalol or atenolol). Two hundred ninety-two patients (152 white and 140 black patients) with essential hypertension characterized by a standing diastolic blood pressure of 105 to 119 mm Hg (inclusive) were recruited for this trial. Patients were randomized to either labetalol (dosage titrated from 200 to 1600 mg/day) or atenolol (dosage titrated from 50 to 100 mg/day). The therapeutic goal was achievement of a standing diastolic blood pressure of 90 mm Hg or less or a fall of 15 mm Hg in diastolic pressure from baseline value at the end of the placebo run in period. At the end of the study there were no significant differences in blood pressure or heart rate changes in the supine position between the labetalol and atenolol groups. In contrast, labetalol produced greater reduction in both the standing systolic and diastolic blood pressure (-12/-13 mm Hg, respectively) compared with atenolol (-7/-9 mm Hg; p less than 0.05; p less than 0.005, respectively). The greatest decrease in blood pressure was observed in white patients receiving labetalol. In black patients the decrease in blood pressure was greater in those treated with labetalol compared with atenolol, particularly with respect to the systolic blood pressure. We conclude that the alpha 1-blocking property of labetalol provides an additional lowering of the blood pressure over that seen with beta 1-blockade alone, especially in the standing position, and this enhanced efficacy is not confined to one radical group.

Maternal ethnicity and its impact on the haemodynamic and blood pressure response to labetalol for the treatment of antenatal hypertension

“…Indeed, this study found that there was, in fact, a small increase in the supine SBP among black hypertensives following labetalol therapy, that higher doses of labetalol were required among black populations to achieve BP control, and that atenolol was markedly more effectively than labetalol in lowering supine BPs among black patients. 29 We also note a smaller study from Jennings and Parsons 30 which also shows that labetalol was more effective in white populations.…”

Improving Blood Pressure Control in a Pharmacist‐Managed Hypertension Clinic

“…2,14,15 Studies have suggested that African-Americans with hypertension are more responsive to diuretics and calcium channel blockers than other antihypertensive agents. 13,16,17 This study had inadequate power to detect a significant difference in compliance, health perception, and patient satisfaction. Although no difference in these factors was found, compliance may have been greater in the intervention group.…”

Characterization and treatment of resistant hypertension

“…In these subjects, NSAIDS should be discontinued, spironolactone should be started at 12.5 mg daily and serum potassium and creatinine should be closely monitored; subjects should also be educated to avoid food or supplements rich in potassium. In case the BP is still above target, we prefer combined α-β blockers such as labetalol or carvedilol to pure β-blockers due to their suggested better BP control [38]. If β blockers are contraindicated, peripheral α-blockers may be considered: a recent retrospective study showed that doxazosin at a mean dose of 4 mg/day further decreased SBP by 16 mmHg and DBP by 7 mmHg in subjects with RH [39].…”