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Antihypertensive Treatment With Metoprolol or Hydrochlorothiazide in Patients Aged 60 to 75 YearsReport From a Double-blind International Multicenter Study
John Wikstrand, MD, PhD;
Gudrun Westergren, PhD;
Göran Berglund, MD, PhD;
Daniele Bracchetti, MD;
Antoon Van Couter, MD;
Carlos A. Feldstein, MD;
Kong Siu Ming, MB,BS, FRCP;
Kizuku Kuramoto, MD;
Sten Landahl, MD, PhD;
Eduardo Meaney, MD;
Erling B. Pedersen, MD, PhD;
Karl H. Rahn, MD, PhD;
John Shaw, MB,BS, PhD;
Anthony Smith, MA, DM, FRCP;
Hendrika Waal-Manning, MBChB, MD
JAMA. 1986;255(10):1304-1310.
Abstract
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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, 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.
(JAMA 1986;255:1304-1310)
Author Affiliations
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From the Departments of Clinical Physiology (Dr Wikstrand), Medicine I (Dr Berglund), and Geriatric and Long-term Care Medicine (Dr Landahl), University of Göteborg (Sweden); the Sahlgrenska Hospital, Göteborg (Drs Wikstrand and Berglund); the Vasa Hospital, Göteborg (Dr Landahl); the Medical Department, AB Hässle, Mölndal, Sweden (Dr Westergren); the Department of Cardiology, Maggiore Hospital, Bologna, Italy (Dr Bracchetti); the Department of Geriatrics, AZ St Jan Hospital, Brugge, Belgium (Dr Van Couter); Hypertension Division, Hospital de Clinicas Jose de San Martin, Buenos Aires (Dr Feldstein); Queen Elizabeth Hospital, Hong Kong (Dr Kong); Tokyo Metropolitan Geriatric Hospital (Dr Kuramoto); the Cardiovascular Unit, Primero; de Octubre Hospital, Mexico City (Dr Meaney); the Department of Medicine, Arhus (Denmark) Kommunehospital (Dr Pedersen); the Department of Internal Medicine, University of Limburg, Ziekenhuis St Annadal, Maastricht, the Netherlands (Dr Rahn); the Department of Clinical Pharmacology, University of Sydney (Australia) (Dr Shaw); the Department of Clinical Pharmacology, Royal Newcastle (Australia) Hospital (Dr Smith); and the Department of Medicine, University of Otago Medical School, Dunedin, New Zealand (Dr Waal-Manning).
Footnotes
Reprint requests to Department of Clinical Physiology, University of Göteborg, Sahlgrenska Hospital, S-413 45 Göteborg, Sweden (Dr Wikstrand).
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