Effect on intra-arterial blood pressure of slow release metoprolol combined with placebo or chlorthalidone.

Kieso, H; Gould, BA; Mann, Stewart; Hornung, R. S.; Altman, Douglas G.; Raftery, E. B.

doi:10.1136/bmj.287.6394.717

Cited by 10 publications

(2 citation statements)

References 13 publications

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“…Our study reported a fall of -27/-14 mmHg in SBP/ DBP after 4 weeks of therapy with metoprolol XL 25 mg/chlorthalidone 6.25 mg, confirming efficacy of this combination. This fall was similar to that reported in literature (-31/-17) but this was achieved with metoprolol 200 mg/chlorthalidone 25 mg [ 24 ]. One of the major reasons for low usage of chlorthalidone in clinical practice is concern regarding adverse metabolic effects such as hypokalemia, hyponatremia, hyperuricemia and impaired glucose tolerance.…”

Section: Discussionsupporting

confidence: 90%

Antihypertensive efficacy of metoprolol XL/Low dose chlorthalidone (6.25 mg) combination: a randomized, comparative study in Indian patients with mild-to-moderate essential hypertension

et al. 2009

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ObjectiveHigh blood pressure is one of the most important risk factors, directly responsible for increasing the cardiovascular morbidity and mortality. The primary objective was to evaluate the efficacy of metoprolol XL/chlorthalidone against metoprolol XL/hydrochlorothiazide with respect to mean fall in systolic and diastolic blood pressure. The secondary objective was to compare the response rates and to evaluate the tolerability of study medications in patients with mild-tomoderate essential hypertension.MethodsTotal 130 eligible patients (65: metoprolol XL 25 mg/chlorthalidone 6.25 mg; 65: metoprolol XL 25 mg/HCTZ 12.5 mg) were enrolled in this randomized, comparative, multicentric, 12-weeks study. Sixty-two patients from each group completed the study. After 4-weeks of treatment, non-responders from chlorthalidone 6.25 mg combination group were shifted to metoprolol XL 50 mg/chlorthalidone 12.5 mg and non-responders from HCTZ 12.5 mg combination group were escalated to metoprolol XL 50 mg/HCTZ 12.5 mg.ResultsThe study treatment groups were comparable with respect to demography and baseline disease characteristics. Both the starting therapies were comparable with respect to mean fall in SBP (p = 0.788) and DBP (p = 0.939), and response rates (p = 1.0) after 4-weeks of therapy. Also both the step-up therapies showed similar mean fall in SBP (p = 0.277) and DBP (p = 0.507) at the end of 12-weeks. However, significantly more number of patients from chlorthalidone 12.5 mg/metoprolol XL 50 mg group responded to therapy as compared to that from HCTZ 12.5 mg/metoprolol XL 50 mg group (p = 0.045). All the reported adverse events were of mild-to-moderate intensity. There were no clinically significant trends in electrolytes (Na+, K+, Cl-)and fasting blood sugar, evident across the treatment groups.ConclusionChlorthalidone in combination with metoprolol XL is as effective and well tolerated as widely used combination of metoprolol XL/HCTZ, thus providing an alternative therapeutic option.

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Section: Discussionsupporting

confidence: 90%

Antihypertensive efficacy of metoprolol XL/Low dose chlorthalidone (6.25 mg) combination: a randomized, comparative study in Indian patients with mild-to-moderate essential hypertension

et al. 2009

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“…"Without withdrawal of medication it is not possible to fully evaluate the impact of the intensive antihypertensive treatment on the blunted diurnal variation of blood pressure. However, it is unlikely that the antihypertensive medication itself primarily induces an abnormal circadian pattern of 24.00 the blood pressure since this is unaffected in essential hypertension by both ACE-inhibitors and beta-blockers combined with diuretics [29,30]. Moreover we have previously :reported night/day ratios in patients with early diabetic nephropathy treated with ACE-inhibitors, metoprolol and diuretics which are comparable to the values in the untreated group D3 ill the present study [31].…”

Section: Discussionsupporting

confidence: 73%

Circadian variation of blood pressure in patients with diabetic nephropathy

et al. 1992

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The association between diurnal blood pressure variation and diabetic nephropathy was assessed in four groups of Type 1 (insulin-dependent) diabetic patients who underwent 24-h ambulatory blood pressure monitoring using an oscillometric technique. Patients with nephropathy, who had never been treated for hypertension (group D3, n = 13), were individually matched for age, sex and diabetes duration to a group of microalbuminuric patients (D2, n = 26), to normoalbuminuric patients (D1, n = 26) and to healthy control subjects (C, n = 26). Group D3 was also compared to patients with advanced nephropathy receiving treatment for hypertension, mainly a combination of angiotensin converting enzyme inhibitors, metoprolol and diuretics (D4, n = 11). In group D3 24-h diastolic blood pressure (85 +/- 8 mm Hg) was comparable to the results obtained in D4 (85 +/- 8 mm Hg) but significantly higher than in D2 (78 +/- 7 mm Hg), D1 (73 +/- 7 mm Hg) and C (73 +/- 7 mm Hg, p < 0.05, Tukey's test). The night/day ratio of diastolic blood pressure was higher in D3 (86 +/- 5%) and D2 (85 +/- 7%) than in C (80 +/- 7%, p < 0.02). This ratio was also elevated in group D4 (94 +/- 8%) compared to D3 (p < 0.05) corresponding to a marked smoothing of the diurnal blood pressure curve. The 24-h heart rate (beats per min) was significantly elevated in D3 (84 +/- 8) and D2 (80 +/- 10) compared with C (73 +/- 11, p < 0.05 Tukey's test), suggesting the presence of parasympathetic neuropathy.(ABSTRACT TRUNCATED AT 250 WORDS)

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Blood pressure lowering efficacy of diuretics as second-line therapy for primary hypertension

Chen

Heran

Wright

2009

Cochrane Database of Systematic Reviews

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Thiazides when given as a second-line drug have a dose related effect to lower blood pressure that is similar to when they are added as a first-line drug. This means that the BP lowering effect of thiazides is additive. Loop diuretics appear to have a similar blood pressure lowering effect as thiazides at 1 times the recommended starting dose. Because of the short duration of the trials and lack of reporting of adverse events, this review does not provide a good estimate of the incidence of adverse effects of diuretics given as a second-line drug.

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Effect on intra-arterial blood pressure of slow release metoprolol combined with placebo or chlorthalidone.

Cited by 10 publications

References 13 publications

Antihypertensive efficacy of metoprolol XL/Low dose chlorthalidone (6.25 mg) combination: a randomized, comparative study in Indian patients with mild-to-moderate essential hypertension

Antihypertensive efficacy of metoprolol XL/Low dose chlorthalidone (6.25 mg) combination: a randomized, comparative study in Indian patients with mild-to-moderate essential hypertension

Circadian variation of blood pressure in patients with diabetic nephropathy

Blood pressure lowering efficacy of diuretics as second-line therapy for primary hypertension

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