Efficacy of four antihypertensive drugs (clonidine, enalapril, nitrendipine, oxprenolol) on stress blood pressure.
The impact of 4 antihypertensive drug regimens on blood pressure (BP) during everyday life stress and on BP during experimental stress in the laboratory was examined in an open clinical study. Sixty middle-aged men with mild-to-moderate essential hypertension never previously treated were treated either with low-dose clonidine (n = 10), oxprenolol (n = 20), nitrendipine (n = 20) or enalapril (n = 10). Before therapy, all 4 groups did not differ in age, weight, degree of obesity, BP at work site and casual BP measured in the outpatient clinic. After 6 months of effective therapy (casual BP within the normotensive range), casual diastolic BP was identical among the 4 groups, whereas systolic BP was lower in patients treated with clonidine or oxprenolol than in those who received enalapril. A disparate pattern of antihypertensive efficacy among the 4 groups emerged when stress BP was compared, with average ambulatory BP higher in patients receiving clonidine or enalapril than in those who had oxprenolol or nitrendipine. During ambulatory BP monitoring, patients treated with oxprenolol had the lowest level at each level of physical activity and self-reported emotional arousal. During bicycle exercise, patients receiving clonidine had the highest increase in systolic BP and those administered oxprenolol the lowest, whereas the BP response during mental stress was similar among all 4 therapeutic groups. The analysis of the hemodynamic response pattern during mental stress unmasked further disparities. Oxprenolol provoked an abnormal hemodynamic response during mental stress tests (increase in total peripheral resistance), whereas nitrendipine and enalapril preserved the physiological hemodynamic profile (decrease of total peripheral resistance).(ABSTRACT TRUNCATED AT 250 WORDS)
Schmieder
R E
RE
Department of Medicine, University of Bonn, Bonn-Venusberg, Federal Republic of Germany.
Bähr
M
M
Langewitz
W
W
Rüddel
H
H
Schächinger
H
H
Schulte
W
W
D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination / Q000379:methods; D002986:Clinical Trials as Topic; D003000:Clonidine / Q000627:therapeutic use*; D004656:Enalapril / Q000627:therapeutic use*; D005080:Exercise Test; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008991:Monitoring, Physiologic; D009568:Nitrendipine / Q000627:therapeutic use*; D010096:Oxprenolol / Q000627:therapeutic use*; D013312:Stress, Physiological / Q000503:physiopathology*; D013315:Stress, Psychological / Q000503:physiopathology
D010096:Oxprenolol; D004656:Enalapril; D009568:Nitrendipine; D003000:Clonidine