Diuretics, beta‐blockers or both as treatment for essential hypertension.

Abstract

1 Patients with borderline (group I) and sustained hypertension (group II) were treated with 3-blocking drugs, diuretics and the combination of both. In the two groups of patients the antihypertensive effectiveness of both short-term intravenous or chronically oral propranolol was directly related to the extent to which the drug produced an absolute reduction in plasma renin activity (PRA). No such a correlation could be obtained with pindolol. In group I following ,B-blockade, day-night profiles of PRA were similar to those observed in group II before treatment. Thus, in this latter subgroup, low renin profiles might reflect reduced ,3-adrenergic activity. 2 When the chronically 13-blockaded patients were changed to chronic diuretic therapy it became evident that young hypertensive patients of group II showed a more pronounced BP response than the patients of group I. In those patients of group II in whom pressure was not controlled by the diuretic alone, combination with a 13-blocker led to pressure normalization. 3 The 13-blocking drug induced reduction in pressure was greater in the 25-35 yr olds, than in those older than 55. In contrast, the antihypertensive effect of the diuretic was more pronounced in the 55-70 yr olds than in those younger than 40. 4 It is concluded that sympathetic nervous system activity mainly determined PRA as well as antihypertensive effectiveness of both the P-blockers and the diuretics. As to outpatient management it is proposed that with the exception of young borderline hypertensives who seem to respond best to 13-blockers, initial antihypertensive drug therapy may consist of a diuretic agent. If the antihypertensive effect of the diuretic is insufficient, combination with a P-blocking drug could be used to achieve the best effect.

Antihypertensive β-Blockade and the Renin-Angiotensin System

“…However, the target was reached in only 50% of those aged 4 0 -6 0 years, and in a mere 20% of patients above the age of 60 years. The predictive value of age has also been confirmed by others (31,32). Due to the fact that older patients and those with a low renin respond better to diuretics than to /3-blocker monotherapy adds complementary confirmation to the concept of a treatment strategy based on age and renin (33)(34)(35).…”

A study of the antihypertensive action of xipamide using ambulatory intra‐arterial monitoring.

“…Two aspects are of particular interest. Firstly, the degree of antihypertensive activity seems greater than might be anticipated from previous reports of the effects of diuretics (Stumpe & Overlack, 1979;Freis, 1960), and is more in keeping with the reported effects of f3-adrenoceptor blocking agents ). Xipamide appears to exercise control throughout the whole day including the hours of rapid rise between 05.00 h and 10.00 h. Both of these facts may be of considerable clinical importance .…”

Renin and Aldosterone Measurements in the Management of Arterial Hypertension

“…Heterogeneity of BP response to different antihypertensive agents is well-known among clinicians [48]. It was first recognized when earlier studies with diuretics and β-blockers reported a differential response to these drugs among hypertensive people [49][50][51][52]. Such variability of response was later con-Review firmed also with other antihypertensive drug classes, such as ACEi and calcium channel blockers (CCBs) [53][54][55][56][57][58][59].…”