Antihypertensive treatment with metoprolol or hydrochlorothiazide in patients aged 60 to 75 years. Report from a double-blind international multicenter study
J. Wikstrand, G. Westergren, G. Berglund, D. Bracchetti, A. Van Couter, C. A. Feldstein, K. S. Ming, K. Kuramoto, S. Landahl, E. Meaney and al. et
In a randomized double-blind study (N = 562), a traditional treatment
schedule, starting antihypertensive treatment in elderly hypertensive
patients (60 to 75 years old) with 25 mg of hydrochlorothiazide once daily
and doubling the dose if a satisfactory response was not achieved, was
compared with antihypertensive treatment of 100 mg of metoprolol once
daily, adding 12.5 mg of hydrochlorothiazide for patients whose response
was not satisfactorialy achieved with metoprolol alone. Systolic and
diastolic blood pressure was significantly reduced with both regimens. The
frequency rates of responders (diastolic blood pressure, less than or equal
to 95 mm Hg) in the metoprolol group and the hydrochlorothiazide group were
50% and 47% after four weeks and 65% and 61% after eight weeks,
respectively. There were no significant differences in total symptom score
or single symptoms between the regimens, but significantly more patients
had hypokalemia and hyperuricemia with the hydrochlorothiazide regimen.
Thus, we conclude that beginning antihypertensive treatment with 100 mg of
metoprolol once daily and adding a small dose of hydrochlorothiazide (12.5
mg) in patients whose response is not satisfactory with metoprolol alone
appears to be effective and safe in elderly hypertensive patients.
