title: A diuretic is more effective than a beta-blocker in hypertensive patients not controlled on amlodipine and lisinopril.
abstract: The combination of an angiotensin-converting enzyme inhibitor and a calcium antagonist has a synergistic effect in patients with more severe hypertension. However, when this combination fails to control blood pressure, it is not clear which drug is then additive. The aim of this work was to study in a double-blind, randomized, crossover design the effect on blood pressure of the addition of either a thiazide diuretic (bendrofluazide, 5 mg once daily) or a beta-blocker (atenolol, 100 mg once daily) or placebo each for a month in hypertensive patients who are not adequately controlled on the combined treatment of amlodipine 5 mg once daily and lisinopril 5 mg twice daily. Eighteen patients with a supine diastolic pressure of more than 90 mm Hg after at least 1 month on the combined treatment of amlodipine and lisinopril were enrolled in the study. The results show that in patients whose blood pressures are not controlled by the combination of amlodipine and lisinopril, the addition of bendrofluazide 5 mg once daily causes a significant fall in blood pressure compared with placebo and a significantly greater fall than 100 mg atenolol once daily.
authors.affiliation: Department of Medicine, St George's Hospital Medical School, London, UK.
authors.forename: T F
authors.initials: TF
authors.lastname: Antonios
authors.forename: F P
authors.initials: FP
authors.lastname: Cappuccio
authors.forename: N D
authors.initials: ND
authors.lastname: Markandu
authors.forename: G A
authors.initials: GA
authors.lastname: Sagnella
authors.forename: G A
authors.initials: GA
authors.lastname: MacGregor
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D017311:Amlodipine / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D001539:Bendroflumethiazide / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D018592:Cross-Over Studies; D004232:Diuretics; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy*; D017706:Lisinopril / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D017311:Amlodipine; D001262:Atenolol; D001539:Bendroflumethiazide; D017706:Lisinopril