Summary
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⩽90 mmHg (p<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⩽90 mmHg (p<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⩽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 ⩽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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Angervall G, Bystedt U (1974) The effects of alprenolol and alprenolol in combination with saluretics in hypertension. Acta Med Scand 39 [Suppl]: 554
Beermann B, Groschinsky-Grind M (1977) Pharmacokinetics of hydrochlorothiazide in man. Eur J Clin Pharmacol 12: 297–303
Beermann B, Groschinsky-Grind M (1978) Antihypertensive effect of various doses of Hydrochlorothiazide and its relation to the plasma level of the drug. Eur J Clin Pharmacol 13: 195–201
Berglund G, Andersson O (1976) Low doses of hydrochlorothiazide in hypertension. Eur J Clin Pharmacol 10: 177–182
Beta-blocker Heart Attack Study Group (1981) The beta-blocker heart-attack trial. J Am Med Assoc 246: 2037
Beta-blocker Heart Attack Trial Study Group (1982) A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. J Am Med Assoc 247: 1707
Castenfors H (1977) Long term effect of timolol and hydrochlorothiazide, or hydrochlorothiazide and amiloride, in essential hypertension. Eur J Clin Pharmacol 12: 97–103
Degnbol B, Dorph S, Marner T (1973) The effect of different diuretics on elevated blood pressure and serum potassium. Acta Med Scand 193: 407–410
De Plaen JF, vander Elst E, van Ypersele de Strihou C (1981) Penbutolol or hydrochlorothiazide once a day in hypertension. A controlled study with home measurements. Br J Clin Pharmacol 12: 215–221
Fagard R, Amery A, de Plaen JF, Lijnen P, Missotten A (1977) Relative value of beta-blockers and thiazides for initiating anti-hypertensive therapy. Beta-blocker or thiazides in hypertension. Acta Cardiol 31: 411–426
Galloway DB, Beattie AG, Petrie JC (1974) Practolol and bendrofluazide in treatment of hypertension. Br Heart J 36: 867–871
Green KG (1975) A Multicenter International Study: improvement in prognosis of myocardial infarction by long-term betaadrenoceptor blockade using practolol. Br Med J 3: 735–740
Harris AM, Woollard KV, Tweed JA (1976) A study of once daily tenormin (atenolol) in hypertension: some implications in patient compliance. J Int Med Res 4: 3447
Henning R, Karlberg BE, Odar-Cederlöf J, Andersson PO, Lins LE, Nilsson OR, Tolagen K (1980) Timolol and hydrochlorothiazide-amiloride in primary hypertension. Clin Pharmacol Ther 28: 707–714
Jäättelä A (1981) Fixed combination of sotalol and hydrochlorothiazide in the treatment of uncomplicated hypertension. Eur J Clin Pharmacol 19: 395–401
Julian DG, Prescott RJ, Jackson FS, Szekely P (1982) Controlled trial of sotaol for one year after myocardial infarction. Lancet 1: 1142
Lederballe Pedersen O (1976) Comparison of metoprolol and hydrochlorothiazide as antihypertensive agent. Eur J Clin Pharmacol 10: 381–385
Lederballe Pedersen O, Mikkelsen E (1978) Individual factors influencing the responses to a beta-adrenergic blocking agent given alone and in combination with a diuretic in arterial hypertension. Eur J Clin Pharmacol 16: 311–317
Louis WJ, Rand MJ, McNeill JJ, Drummer O, Jarrott B (1979) Clinical pharmacology of adrenergic-blocking drugs. Cardiology 64 [Suppl 1]: 96–104
Marshall AJ, Barrit DW, Harry JD (1977) Dose response and frequency of administration of atenolol in hypertension — once daily treatment with beta-blockade. Postgrad Med J 53 [Suppl 3]: 168
Mc Leod PJ, Ogilvie RI, Ruedy J (1970) Effects of large and small doses of hydrochlorothiazide in hypertensive patients. Clin Pharmacol Ther 11: 733–739
Morgan TO, Sabto J, Anavekar SN, Louis WJ, Doyle AL (1974) A comparison of beta adrenergic blocking drugs in the treatment of hypertension. Postgrad Med J 50: 253
Muckadell OBS, Gyntelberg F (1973) The antihypertensive effect of a new beta-blocking agent pindolol compared with chlorthalidone. Eur J Clin Pharmacol 5: 210–213
Nadeau J, Ogilvie R, Ruedy J, Brossard JJ (1980) Acebutolol and hydrochlorothiazide in essential hypertension. Clin Pharmacol Ther 28: 296–301
Neuvonen PJ, Pentikäinen PJ, Jounela AJ (1978) Effect of diuretic, β-adrenoceptor blocking agent and their combination on elevated blood pressure and serum potassium: a cross-over study. Br J Clin Pharmacol 6: 363–367
The Norweigan Multicentre Study Group (1981) Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 304: 801–807
O'Brien ET, McKinnon J (1972) Propranolol and polythiazide in the treatment of hypertension. Br Heart J 34: 1042–1044
Prichard BNC, Owens CWT (1980) Mechanism of anti-hypertensive action of β-adrenergic blocking drugs. Cardiology 66 [Suppl 1]: 1–11
Stewart I McD G (1976) Compared incidence of first myocardial infarction in hypertensive patients under treatment containing propranolol or excluding β-receptor blockade. Clin Sci Molec Med 51 [Suppl 3]: S09s-S11s
Upton N, Tweed JA, Barher NP (1977) A double-blind controlled comparison of once daily and twice daily atenolol in the treatment of hypertension. Acta Therapeutica 3: 15
Wilhelmsson C, Vedin JA, Wilhelmsen L, Tibblin G, Werkö L (1974) Reduction of sudden deaths after myocardial infarction by treatment with aprenolol. Lancet 2: 1157–1160
Zacharias FJ, Hayes PJ, Cruickshank JM (1977) Atenolol in hypertension: a double-blind comparison of the response to three different doses. Postgrad Med J 53 [Suppl 3]: 114
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
van der Veur, E., ten Berge, B.S., Donker, A.J.M. et al. Comparison of hydrochlorothiazide and atenolol as initial treatment in uncomplicated hypertension. Eur J Clin Pharmacol 26, 157–162 (1984). https://doi.org/10.1007/BF00630280
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00630280