Summary
Twenty patients (mean age 49±4 (SEM) yr) with mild to moderate essential hypertension were studied during placebo conditions, following 6 weeks of chlorthalidone monotherapy and 6 to 28 weeks of combined beta-blocker-chlorthalidone treatment, or vice versa. Compared to chlorthalidone therapy alone, addition of a beta-blocker to this diuretic caused a further blood pressure reduction in 11 patients (Responders); in 9 patients addition of a beta-blocking agent failed to further reduce blood pressure (Non-responders). Supine and upright plasma renin, aldosterone, norepinephrine and epinephrine levels and catecholamine excretion rates were always comparable between Responders and Non-responders. In both groups plasma and urinary norepinephrine or epinephrine values were not significantly altered following addition of a beta-blocker; heart rate and plasma renin activity were decreased in both groups to a similar extent. It is concluded that the antihypertensive mechanism of beta-blockers given to diuretic treated patients with essential hypertension is independant of renin and not associated with changes in plasma or urinary catecholamines.
Zusammenfassung
20 Patienten (mittleres Alter 49±3 (SEM) Jahre) mit leichter bis mittelschwerer essentieller Hypertonie wurden nach einer 4wöchigen Placebophase, 6 Wochen Chlorthalidon-Monotherapie, sowie nach 6 bis 28 Wochen Kombinationstherapie mit Chlorthalidon und einem Betablocker oder in umgekehrter Reihenfolge untersucht. Verglichen mit Chlorthalidon-Monotherapie führte die Zugabe eines Betablockers zum Diuretikum bei 11 Patienten zu einer weiteren Blutdrucksenkung (Responder-Gruppe); bei 9 Patienten führte die Zugabe eines Betablockers zu keiner zusätzlichen Blutdrucksenkung (Non-responder-Gruppe). Die im Liegen und Stehen gemessenen Blutspiegel von Renin, Aldosteron, Noradrenalin und Adrenalin sowie die Katecholamin-Ausscheidung im Urin unterschieden sich in keiner Studien-Phase zwischen Responder- und Non-responder-Gruppe. In beiden Gruppen wurden die Plasmaoder Urin-Katecholaminspiegel durch die Zugabe eines Betablockers nicht signifikant verändert, während die Plasmareninaktivität und die Pulsfrequenz dadurch gleichermaßen erniedrigt wurden. Unsere Befunde weisen darauf hin, daß die blutdrucksenkende Wirkung von Betablockern bei Diuretika-behandelten Patienten Renin-unabhängig ist und auch nicht mit Veränderungen der Plasma- oder Urinkatecholamine einhergeht.
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Supported in part by the Swiss National Science Foundation
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Meier, A., Weidmann, P. & Ziegler, W.H. Responses of catecholamines and blood pressure to beta-blockade in diuretic-treated patients with essential hypertension. Klin Wochenschr 60, 27–32 (1982). https://doi.org/10.1007/BF01721584
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DOI: https://doi.org/10.1007/BF01721584