Comparison of enalapril and atenolol in mild to moderate hypertension.
OBJECTIVE
Short-term therapy with angiotensin converting enzyme (ACE) inhibitors for hypertension is effective and well tolerated, and compared with beta blockers, may cause fewer adverse reactions. Furthermore, enalapril has been observed to have a greater effect on systolic blood pressure than beta blockers. We therefore decided to compare the ACE inhibitor enalapril and the beta blocker atenolol as monotherapy in a double-blind study of patients with mild to moderate hypertension.


METHODS
After a four-week placebo run-in period, 162 patients were allocated randomly to receive atenolol (50 to 100 mg daily) or enalapril (20 to 40 mg daily) for 12 weeks. To assess the influence of these drugs on quality of life, a series of psychologic tests was performed, and a subset of patients also underwent treadmill exercise and pulmonary function tests.


RESULTS
In 147 patients who completed the study, enalapril reduced supine blood pressure by 19/12 mm Hg, compared with 9/7 mm Hg for atenolol (p less than 0.001/p less than 0.005). The modest blood pressure response to atenolol was not due to poor compliance. A target blood pressure of 140/90 mm Hg or less was achieved by 35 percent of enalapril-treated atenolol (p less than 0.01). The frequency and severity of adverse effects with the two drugs were similar, and few important differences emerged from the quality-of-life assessments.


CONCLUSIONS
At the doses used, enalapril induced a greater short-term blood pressure response than atenolol; long-term studies of its safety and efficacy are required.
Herrick
A L
AL
Glasgow Blood Pressure Clinic, University of Glasgow, Scotland.
Waller
P C
PC
Berkin
K E
KE
Pringle
S D
SD
Callender
J S
JS
Robertson
M P
MP
Findlay
J G
JG
Murray
G D
GD
Reid
J L
JL
Lorimer
A R
AR
D000293:Adolescent; D000328:Adult; D000368:Aged; D001262:Atenolol / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002986:Clinical Trials as Topic; D004311:Double-Blind Method; D004656:Enalapril / Q000627:therapeutic use*; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008568:Memory / Q000187:drug effects; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012119:Respiration / Q000187:drug effects
D001262:Atenolol; D004656:Enalapril