Current Recommendation for First Line Therapy of Uncomplicated Hypertension

  • Roland E. Schmieder
  • Jürgen K. Rockstroh
  • Franz H. Messerli
Part of the International Yearbook of Nephrology 1991 book series (IYNE, volume 3)


According to the World Health Organisation patients with arterial pressure equal or greater than 140/90 mm Hg but less than 160/95 mm Hg are said to have borderline hypertension, whereas those with pressure values equal or greater than 160/95 mm Hg are considered to have established hypertension (1). In westernized populations the overall prevalence of borderline hypertension ranges from 10 to 20 percent (2). In the United States the subjects with borderline and established arterial hypertension have been estimated to amount to about 25 and 35 million people respectively (3, 4). Differences in reported epidemiologic data on prevalence of arterial hypertension are mostly due to the various approaches of defining hypertension and age distribution of the studied populations. A nearly linear rise in systolic pressure can be observed with advancing age in both sexes, whereas diastolic pressure reaches its maximum at age 50 to 60 years (5). According to data from the Framingham cohort prevalence rates for definite hypertension approximated 40 to 50% (6) in those older than 65 years.


Hypertensive Patient Essential Hypertension Left Ventricular Hypertrophy Calcium Antagonist Antihypertensive Agent 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    World Health Organization Expert Committee: Arterial hypertension. WHO Technical Report Service, 628,1978.Google Scholar
  2. 2.
    Schmieder RE, Messeli FH, Riiddel H: Risks for arterial hypertension. Cardiology Clinics, 4(No. 1): 57–66, 1986.PubMedGoogle Scholar
  3. 3.
    National Center for Health Statistics: Hypertension in adults 25-74 years of age. Hyattsville, Maryland, United States 1971-75.Google Scholar
  4. 4.
    National High Blood Pressure Education Program Coordinating Committee: New hypertension prevalence data and recommended public statements. Betheda, Maryland, National Heart, Lung and Blood Institute, February 1978.Google Scholar
  5. 5.
    Drizd T, Dannenberg AL, Engel A: Blood pressure levels in persons 18–74 years of age in 1976–80, and trends in blood pressure from 1960 to 1980 in the United States. Hyattsville, Maryland, US Department of Health and Human Services; DHHS publication no (PHS) 86-1684 (Vital Health Statistics Series No. 11), 1986.Google Scholar
  6. 6.
    Vokonas PS, Kannel WB, Cupples LA: Epidemiology and risk of hypertension in the elderly: The Framingham Study. J Hypertension, 6 (Suppl 1): S3–S9, 1988.Google Scholar
  7. 7.
    The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: The 1984 report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure. Arch Intern Med, 144:1045–1057,1984.Google Scholar
  8. 8.
    The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: The 1988 report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure. Arch Intern Med, 148:1023–1038,1988.CrossRefGoogle Scholar
  9. 9.
    Messerli FH, Garavaglia GE: Cardiodynamics of hypertension: A guide to selection of therapy. J Clin Hypertension, 3: S100–S108, 1986.Google Scholar
  10. 10.
    Messerli FH, DeCarvalho JGR, Christie B, FrÖhlich ED: Systemic and regional hemodynamics in low, normal, and high cardiac output borderline hypertension. Circulation, 58: 441,1978.PubMedCrossRefGoogle Scholar
  11. 11.
    Messerli FH: Individualization of antihypertensive therapy: An approach based on hemodynamics and age. J Clin Pharmacol, 21: 517–528,1981.PubMedGoogle Scholar
  12. 12.
    Julius S, Pascual AV, Sannerstedt R, Mitchell C: Relationship between cardiac output and peripheral resistance in borderline hypertension. Circulation, 43: 382–390,1971.PubMedCrossRefGoogle Scholar
  13. 13.
    Per Lund-Johansen: Treatment of essential hypertension today. The role of beta-blockers, calcium antagonists, and ACE-inhibitors. Med Clin N Am, 71: 947–957,1987.Google Scholar
  14. 14.
    Folkow B: Physiological aspects of primary hypertension. Physiol Review, 62: 347–504,1982.Google Scholar
  15. 15.
    Schmieder RE, Messerli FH, Garavaglia GE, Schächinger H: Disproportionate decrease in renal blood supply with aging in essential hypertension. Circulation, 80 (Suppl II): 286,1989.Google Scholar
  16. 16.
    Castleman B, Smithwick RH: The relation of vascular disease to the hypertensive state. JAMA, 121: 1256–1261, 1943.CrossRefGoogle Scholar
  17. 17.
    Messerli FH, Ventura HO, Elizardi DJ, Dunn FG, Fröhlich ED: Hypertension and sudden death: Increased ventricular ectopy activity in left ventricular hypertrophy. Am J Med, 77: 18–22,1984.PubMedCrossRefGoogle Scholar
  18. 18.
    Kannel WD: Prevalence and natural history of electrocardiographic left ventricular hypertrophy. Am J Med, 75 (Suppl 3A): 4–11, 1983.PubMedCrossRefGoogle Scholar
  19. 19.
    Fröhlich ED, Tarazi RC: Is arterial pressure the sole factor responsible for hypertensive cardiac hypertrophy? Am J Cardiol, 44: 959–963,1979.PubMedCrossRefGoogle Scholar
  20. 20.
    Messerli FH, Losem CJ, Kaesser UR: Left ventricular hypertrophy. Effect of antihypertensive therapy. Drug Therapy, 7: 34–44,1989.Google Scholar
  21. 21.
    Fouad FM, Nakahsima Y, Tarazi RC: Reversal of left ventricular hypertrophy during treatment with antihypertensive agents. Br J Clin Pharmacol, 7: 255–260, 1979.CrossRefGoogle Scholar
  22. 22.
    Tarazi RC, Fouad FM: Reversal of cardiac hypertrophy in humans. Hypertension, 6 (Suppl III): 140–146, 1984.Google Scholar
  23. 23.
    Dunn FG, Ventura HO, Messerli FH, Kobrin I, Fröhlich ED: Time course of regression of left ventricular hypertrophy in hypertensive patients treated with atenolol. Circulation, 76: 254–258, 1987.PubMedCrossRefGoogle Scholar
  24. 24.
    Messerli FH, Nunez BD, Nunez MM, Garavaglia GE, Schmieder RE, Ventura HO: Hypertension and sudden death. Disparate effects of calcium entry blockers and diuretic therapy on cardiac dysrhythmias. Arch Intern Med, 149: 1263–1267,1989.Google Scholar
  25. 25.
    Messerli FH, Ventura HO, Glade LB, et al: Essential hypertension in the elderly: Haemodynamics, intravascular volume, plasma renin activity and circulating catecholamine levels. Lancet, II: 983–986,1983.CrossRefGoogle Scholar
  26. 26.
    Julius S, Esler M: Autonomie nervous cardiovascular regulation in borderline hypertension. Am J Cardiol, 36: 685–696,1975.PubMedCrossRefGoogle Scholar
  27. 27.
    Buhler F: Antihypertensive treatment according to age, plasma renin, and race. Drugs, 35: 495–503, 1988.PubMedCrossRefGoogle Scholar
  28. 28.
    Kaplan NM: Critical comments on recent literature: Age and the response to antihypertensive drugs. Am J Hypertension, 2: 213–215,1989.Google Scholar
  29. 29.
    Messerli FH, Garavaglia G, Schmieder RE, Sundgaard-Riise K, Nunez B, Amodeo C: Disparate cardiovascular findings in men and women with essential hypertension. Ann Intern Med, 107: 158–161, 1987.PubMedGoogle Scholar
  30. 30.
    Levy SB, Talner LB, Coel MN, Holk R, Stone RA: Renal vasculature in essential hypertension: Racial differences. Ann Intern Med, 88:12–16,1978.PubMedGoogle Scholar
  31. 31.
    Finnerty FA Jr: Hypertension is different in blacks. JAMA, 216: 1634,1971.PubMedCrossRefGoogle Scholar
  32. 32.
    Dunn FG, Oigman W, Dreslinksi GR et al: Racial differences in cardiac adaptation in essential hypertension determined by echocardiographic indexes. J Am Coll Cardiol, 1:1348,1983.Google Scholar
  33. 33.
    Schmieder RE, Messerli FH: Obesity hypertension. Med Clin North Am, 71: 991–1002, 1987.PubMedGoogle Scholar
  34. 34.
    Messerli FH, Sundgaard-Riise K, Reisin ED, Dreslinski G, Dunn FG, Fröhlich ED: Disparate cardiovascular effects of obesity and essential hypertension. Am J Med, 74: 809–812,1983.CrossRefGoogle Scholar
  35. 35.
    Schmieder RE, Rockstroh JK, Schächinger H, Messerli FH: Hämodynamische Reaktion während Stress bei Patienten mit Adipositas und essentieller Hypertonie. Hochdruck 9: 81,1989 (Abstract).Google Scholar
  36. 36.
    Perloff D, Sokolow M, Cowan R: The prognostic value of ambulatory blood pressures. JAMA, 249: 2792–1798, 1983.PubMedCrossRefGoogle Scholar
  37. 37.
    Kaplan NM: New approaches to the therapy of mild hypertension. Am J Cardiol, 51: 621–627, 1983.PubMedCrossRefGoogle Scholar
  38. 38.
    Weidmann P, Uehlinger DE, Gerber A: Antihypertensive treatment and serum lipoproteins. J Hypertension, 3: 297–306,1985.CrossRefGoogle Scholar
  39. 39.
    Day JL, Simpson CN, Metcalfe J, Page RL: Metabolic consequences of atenolol and propanolol in treatment of essential hypertension. Br Med J, 1: 77–80,1979.CrossRefGoogle Scholar
  40. 40.
    Pollare T, Lithell H, Berne C: A comparision of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension. N Engl J Med, 321: 868–873, 1989.PubMedCrossRefGoogle Scholar
  41. 41.
    Day JL, Metcalfe J, Simpson CN: Adrenergic mechanism in control of plasma lipid concentrations. Br Med J, 284:145–1148,1982.Google Scholar
  42. 42.
    Pasotti C, Capra A, Fiorella G, Vibelli C, Chierichetti SM: Effects of pindolol and metoprolol on plasma lipids and lipoproteins. Br J Clin Pharmacol, 13: S435–S439,1982.CrossRefGoogle Scholar
  43. 43.
    Sacks FM, Dzau VJ: Adrenergic effects on plasma lipoprotein metabolism. Speculation on mechanisms of action. Am J Med, 80: 71–81,1986.Google Scholar
  44. 44.
    Working Group on Hypertension in Diabetes: Statement on hypertension in diabetes mellitus: Final report Arch Int Med, 147: 830–842,1987.Google Scholar
  45. 45.
    Skarfors ET, Lithell HO, Selinus I, Abery H: Do antihypertensive drugs precipitate diabetes in predisposed men? Br Med J, 298:1147–1152,1989.CrossRefGoogle Scholar
  46. 46.
    Pollare T, Lithell HO, Selinus I, Beme C: Sensitivity to insulin during treatment with atenolol and metoprolol: A randomized, double blind study of effects on carbohydrate and lipoprotein metabolism in hypertensive patients. Br Med J, 298: 1152–1157,1989.CrossRefGoogle Scholar
  47. 47.
    Ferrannini E, Buzzigoli G, Bonadonna R, Giorico MA, Obeggini M, Grazindei L, Pedrinelli R, Brandi L, Bevilacqua S: Insulin resistance in essential hypertension. N Engl J Med, 317: 350–357, 1987.PubMedCrossRefGoogle Scholar
  48. 48.
    Rett K, Lotz M, Wicklmayr M, Fink E, Jauch KW, Günther B, Dietze G: Improved insulin action by ACE inhibition in type II diabetics. Dtsch Med W’Schr, 113: 243–249, 1988.CrossRefGoogle Scholar
  49. 49.
    Schmieder RE, Friedrich G, Neus H, RÜddel H, von Eiff AW: The influence of beta-blockers on cardiovascular reactivity and type A behaviour pattern in hypertensives. Psychosom Med, 45: 417–423,1983.PubMedGoogle Scholar
  50. 50.
    Stamler R, Stamler J, Grimm R, Gosch FC, Elmer P, Dyer A, Berman R, Fishman J, van Heel N, Civinella J, McDonald A: Nutritional therapy for high blood pressure. Final report of a four-year randomized controlled trial — The Hypertension Control Program. JAMA, 257: 1484–1491, 1987.PubMedCrossRefGoogle Scholar
  51. 51.
    Langford HG, Blaufox MD, Oberman A et al: Dietary therapy slows the return of hypertension after stopping prolonged medication. JAMA, 253: 657–664,1985.PubMedCrossRefGoogle Scholar
  52. 52.
    Aristimuno GG, Foster TA, Voors AW et al: Influence of persistent obesity in children on cardiovascular risk factors: The Bogalusa heart study. Circulation, 69: 895–904,1984.PubMedCrossRefGoogle Scholar
  53. 53.
    Langford HG: Drug and dietary intervention in hypertension. Hypertension, 4 (Suppl III): 166–169, 1982.Google Scholar
  54. 54.
    Schmieder RE, Messerli FH, Garavaglia GE, Nunez BD: Dietary salt intake: A determinant of cardiac involvement in essential hypertension. Circulation, 78: 951,1988.PubMedCrossRefGoogle Scholar
  55. 55.
    Schmieder RE, Rockstroh JK, Messerli FH: Dietary salt intake modifies cardiac hypertrophy in essential hypertension. Cardiovasc Rev & Rep, 3: 59–64,1990.Google Scholar
  56. 56.
    MacMahon SW, Norton RN: Alcohol and hypertension: Implications for prevention and treatment. Ann Int Med, 105: 124–125,1986.PubMedGoogle Scholar
  57. 57.
    Shaper SG, Wannamethee G, Whincup P: Alcohol and blood pressure in middle-aged british men. J Hum Hypertension, 2: 166–169,1988.Google Scholar
  58. 58.
    Lang T, Degonlet P, Aime F: Relation between coffee drinking and blood pressure: Analysis of 6,321 subjects in the Paris region. Am J Cardiol, 52: 1238–1242,1983.PubMedCrossRefGoogle Scholar
  59. 59.
    Bonita R: Cigarette smoking, hypertension, and the risk of subarachnoid hemorraghe: A population-based, case-control study. Stroke, 17: 831–835,1986.PubMedCrossRefGoogle Scholar
  60. 60.
    Health and Public Policy Committee, American College of Physicians: Biofeedback for hypertension. Ann Ant Med, 102: 709–715,1985.Google Scholar
  61. 61.
    Patel C, Marmot MG, Terry DJ, et al: Trials of relaxation in reducing coronary risk: Four-year follow-up. Br Med J Clin Res, 290: 1103–1106,1985.CrossRefGoogle Scholar
  62. 62.
    Moser M: Treating hypertension. A review of clinical trials. Am J Med, 81(Suppl 6C): 25–32, 1986.PubMedCrossRefGoogle Scholar
  63. 63.
    Holland BO, Nixon JV, Kuhnert LA: Diuretic-induced ventricular ectopic activity. Am J Med, 70: 762–768,1980.CrossRefGoogle Scholar
  64. 64.
    Hollifield JW, Slaton PE: Thiazide diuretics, hypokalemia and cardiac arrhythmias. Acta Med Scand, 647 (Suppl): 67–73,1981.Google Scholar
  65. 65.
    Medical Research Council Working Party on Mild to Moderate Hypertension: Ventricular extrasystoles during thiazide treatment; Study of MRC Mild Hypertension Trial. Br Med J, 287: 1249–1253,1983.CrossRefGoogle Scholar
  66. 66.
    Kannel WB, Cupples A, D’Agostino, Stokes J: Hypertension, antihypertensive treatment and sudden coronary death. The Framingham Study. Hypertension, 3(Suppl II): II45–II50,1988.Google Scholar
  67. 67.
    Veterans Administration Cooperative Study Group on Antihypertensive Agents: Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA, 213: 1143–1152,1970.CrossRefGoogle Scholar
  68. 68.
    Hypertension Detection and Follow-up Program Cooperative Group: Five-years findings of the Hypertension Detection and Follow-up Program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA, 252: 2562–2571,1979.Google Scholar
  69. 69.
    Report of the Management Committee. The Australian Therapeutic Trial in Mild Hypertension. Lancet, I: 1261–1267,1980.Google Scholar
  70. 70.
    Multiple Risk Factor Intervention Trial Research Group. Baseline rest electrocardiographic abnormalities, antihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial. Am J Cardiol, 55: 1–15,1985.CrossRefGoogle Scholar
  71. 71.
    Prichard BNC: Beta-adrenergic receptor blockade in hypertension, past, present, and future. Br J Clin Pharmacol, 5: 379–390, 1978.PubMedCrossRefGoogle Scholar
  72. 72.
    Hansson L: Beta-adrenergic blockade in essential hypertension. Acta Med Scand, 550(Suppl 3): 7–40, 1973.Google Scholar
  73. 73.
    Kostis JB, Oefelice EA: The hemodynamic effects of pindolol. Current Therapy Respiratory Clinical Group, 33: 494–511,1983.Google Scholar
  74. 74.
    Manin’t Veld AJ, Schalekamp MADH: How intrinsic sympathomimetic activity modultes the hemodynamic responses to beta-adrenoceptor antagonists: Clue to the nature of their antihypertensive mechanisms. Br J Clin Pharmacol, 13(Suppl 2): 2455–2595,1982.Google Scholar
  75. 75.
    Frishman WH: Pindolol: A new beta-adrenoceptor antagonist with partial agonist activity. N Engl J Med, 308: 940–944, 1983.PubMedCrossRefGoogle Scholar
  76. 76.
    Svendson TL, Carlsen JR, Hauling O, et al: A comparison of the acute hemodynamic effects of propanolol and pindolol at rest and during supine exercise. Clinical Science, 59:465–468,1980.Google Scholar
  77. 77.
    Schmieder R, Bähr M, Langewitz W, RÜddel H, Schächingef H, Schulte W: Efficacy of four antihypertensive drugs (clonidine, enalapril, nitrendipine, oxprenolol) on stress blood pressure. Am J Cardiol, 63: 1333–1338,1989.PubMedCrossRefGoogle Scholar
  78. 78.
    Heckenstein A, Frey M, Zorn J, et al: Experimental basis of the long-term therapy of arterial hypertension with calcium antagonists. Am J Cardiol, 56: 3H–14H, 1985.CrossRefGoogle Scholar
  79. 79.
    Messerli FH, Ventura HO: The role of calcium antagonists in hypertension. Drug Therapy Hospital, 9: 39–45, 1982.Google Scholar
  80. 80.
    Zanchetti A: Role of calcium antagonists in systemic hypertension. Am J Cardiol, 59: 7,1987.CrossRefGoogle Scholar
  81. 81.
    Hof RP, Hof-Miyashita A: The renin-angiotensin system modulates the peripheral vascular effects of the calcium antagonist isradipine in anesthetized rabbits. J Cardiovasc Pharmacol, 12: 233–238, 1988.PubMedCrossRefGoogle Scholar
  82. 82.
    Greenberg B, Siemiencfuk D, Browdy D: Hemodynamic effects of PN 200-110 (isradipine) in congestive heart failure. Am J Cardiol, 59: 7013–7014,1987.CrossRefGoogle Scholar
  83. 83.
    Messerli FH, Nunez BD, Nunez MM, Garavaglia GE, Schmieder RE, Ventura HO: Hypertension and sudden death. Disparate effects of calcium entry blockers and diuretic therapy on cardiac dysrhythmias. Arch Intern Med, 149:1263–1267,1989.PubMedCrossRefGoogle Scholar
  84. 84.
    Massie BM, Tubau JF, Szlachcic J: Comparative studies of calcium-channel blockers and ß-blockers in essential hypertension: clinical implications. Circulation, 75(Suppl V): V163–V169, 1987.PubMedGoogle Scholar
  85. 85.
    Ben-Ishay D, Leibel B, Stessman J: Calcium channel blockers in the management of hypertension in the elderly. Am J Med, 81(Suppl 6A): 30–34,1986.PubMedCrossRefGoogle Scholar
  86. 86.
    Fleckenstein A, Frey M, Fleckenstein-GrÜn G: Antihypertensive and arterial anticalcinotic effects of calcium antagonists. Am J Cardiol, 57: 1D–10D, 1986.PubMedCrossRefGoogle Scholar
  87. 87.
    Krebs R: Adverse reactions with calcium antagonists. Hypertension, 5(Suppl 2): II125-II129, 1983.Google Scholar
  88. 88.
    McAuley BJ, Schroeder JS: The use of diltiazem hydrochloride in cardiovascular disorders. Pharmacotherapy, 2:121–131,1982.PubMedGoogle Scholar
  89. 89.
    Kostis JB: Angiotensin converting enzyme inhibitors II. Clinical use. Am Heart J, 116: 1591–1605,1988.CrossRefGoogle Scholar
  90. 90.
    Swartz SL, Williams GH, Hollenberg NK, Moore TJ, Dluhy RG: Converting enzyme inhibition in essential hypertension: The hypotensive response does not reflect only reduced angiotensin II formation. Hypertension, 1:106–111,1979.PubMedCrossRefGoogle Scholar
  91. 91.
    Dzau VJ: Implications of local angiotensin production in cardiovascular physiology and pharmacology. Am J Cardiol, 59: 59A–65A, 1987.PubMedCrossRefGoogle Scholar
  92. 92.
    Dunn FG, Oigman W, Ventura HO, Messerli FH, Kobrin I, Frohlich ED: Enalapril improves systemic and renal hemodynamics and allows regression of left ventricular mass in essential hypertension. Am J Cardiol, 53: 105–108,1983.CrossRefGoogle Scholar
  93. 93.
    Fouad FM, Tarazi RC, Bravo EL: Cardiac and hemodynamic effects of enalapril. J Hypertension, 1 (Suppl): 135–142,1983.Google Scholar
  94. 94.
    The CONSENSUS Trial Study Group: Effects of enalapril on mortality in severe congestive heart failure: Results of the Cooperative North Scandinavian Enalapril Survival Study. N Engl J Med, 316:1429–1435,1987.CrossRefGoogle Scholar
  95. 95.
    Dzau VJ, Colucci WS, Williams GH, et al: Sustained effectiveness of converting enzyme inhibition in patients with severe congestive heart failure. N Engl J Med, 302: 1373–1379, 1980.PubMedCrossRefGoogle Scholar
  96. 96.
    Keane WF, Anderson S, Aurell M, de Zeeun D, Navius RG, Pover G: Angiotensin converting enzyme inhibitors and progressive renal insufficiency. Current experience and future directions. Ann Intern Med, 111: 503–516,1989.Google Scholar
  97. 97.
    Packer M, Lee WH, Medina N, Yushek M, Kessler PD: Functional renal insufficiency during long-term therapy with captopril and enalapril in severe chronic heart failure. Ann Intern Med, 106: 346–354,1987.PubMedGoogle Scholar
  98. 98.
    Hollenberg N: Medical therapy of renovascular hypertension: Efficacy and safety of captopril in 269 patients. Cardiovasc Rev Rep, 4: 854–879,1983.Google Scholar
  99. 99.
    Anderson S, Meyer TW, Rennke HG, Brenner BM: Control of glomerular hypertension limits glomerular injury in rats with reduced renal mass. J Clin Invest, 76: 612–619, 1989.CrossRefGoogle Scholar
  100. 100.
    Zatz R, Dunn BR, Meyer TW, Anderson S, Rennke HG, Brenner BM: Prevention of diabetic glomerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest, 77: 1925–1930, 1986.PubMedCrossRefGoogle Scholar
  101. 101.
    Anderson S, Diamond JR, Karnovsky MJ, Brenner BM: Mechanisms underlying transition from acute glomerular injury to glomerulosclerosis in a rat model of nephrotic syndrome. J Clin Invest, 82: 1757–1768,1988.PubMedCrossRefGoogle Scholar
  102. 102.
    Schmieder RE, Messerli FH, Garavaglia GE, Nunez BD: High intraglomerular pressure — a determinant for early target organ damage in arterial hypertension. J Hypertension, 4(Suppl 5): 261–263,1986.Google Scholar
  103. 103.
    Beta-Blocker Heart Attack Trial Research Group: A randomized trial of propanolol in patients with acute myocardial infarction. I. Mortality results. JAMA, 247: 1707–1704,1982.CrossRefGoogle Scholar
  104. 104.
    Pepince CJ, Feldman RL, Hill JA, et al: Clinical outcome after treatment of rat angina with calcium blockers: comparative experience during the initial year of therapy with diltiazem, nifedipine and verapamil. Am Heart J, 106:1341–1347,1983.CrossRefGoogle Scholar
  105. 105.
    Packer M, Lee WH, Yushak M, Medine N: Comparison of captopril and enalapril in patients with severe chronic heart failure. N Engl J Med, 315: 847–853,1986.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1990

Authors and Affiliations

  • Roland E. Schmieder
    • 1
  • Jürgen K. Rockstroh
    • 1
  • Franz H. Messerli
    • 1
  1. 1.Department of MedicineUniversity of Bonn, Bonn, FRG and Ochsner Medical InstitutionsNew OrleansUSA

Personalised recommendations