This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Report 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
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
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).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Isolated Elevation of Diastolic Blood Pressure : Real or Artifactual?
Blank et al.
Hypertension 1995;26:383-389.
ABSTRACT | FULL TEXT  

Trends in Medication Choices for Hypertension in the Elderly : The Decline of the Thiazides
Monane et al.
Hypertension 1995;25:1045-1051.
ABSTRACT | FULL TEXT  

Selected Factors That Influence Responses to Antihypertensives: Choosing Therapy for the Uncomplicated Patient
Carter et al.
Arch Fam Med 1994;3:528-535.
ABSTRACT  

Systolic Hypertension in the Elderly: Pathophysiology and Management
Mann
Arch Intern Med 1992;152:1977-1984.
ABSTRACT  

A Randomized Controlled Trial of the Effects of Three Antihypertensive Agents on Blood Pressure Control and Quality of Life in Older Women
Applegate et al.
Arch Intern Med 1991;151:1817-1823.
ABSTRACT  

Cost-Benefit Issues in the Practice of Internal Medicine
Friedman and Katt
Arch Intern Med 1991;151:1165-1168.
ABSTRACT  

Treatment of Hypertension in the Elderly
Tjoa and Kaplan
JAMA 1990;264:1015-1018.
ABSTRACT  

Hypertension in Elderly Patients
Applegate
ANN INTERN MED 1989;110:901-915.
ABSTRACT  

Primary Prevention With Metoprolol in Patients With Hypertension: Mortality Results From the MAPHY Study
Wikstrand et al.
JAMA 1988;259:1976-1982.
ABSTRACT  

Are the Days of the Sphygmomanometer Past?
Tifft
Arch Intern Med 1988;148:518-519.
ABSTRACT