A comparison of selected antihypertensives and the use of conventional vs ambulatory blood pressure in the detection and treatment of hypertension.
This multicenter, randomized, double-blind, parallel group study was undertaken to determine the effectiveness of selected antihypertensives (doxazosin, amlodipine, enalapril, and bendrofluazide) in maintaining 24-hour control of blood pressure (BP). The predictive value of ambulatory (A)BP versus clinic (C)BP measurements as a method for detecting patients with hypertension was also evaluated. A total of 204 patients were screened and of these 110 were diagnosed as mild to moderately hypertensive with clinic diastolic BP 100-110 mm Hg (> or =95 mm Hg in patients with coronary heart disease risk factors). The 4 antihypertensives were all equally effective at controlling BP over 24 h, as shown by 24-hour ABP measurements. The incidence of adverse events was similar for all 4 treatment groups; headache was the most common event, being reported by 22 patients (20%). There was a clinically relevant reduction in total cholesterol for the doxazosin (-15.4 mg/dl) and amlodipine (-11.6 mg/dl) treatment groups in comparison with enalapril and bendrofluazide. Our results from ABP measurements suggest that the antihypertensives studied are effective first-line therapy in the regulation of hypertension and that ABP is a reproducible measure. ABP may also be useful in identifying patients with various types of high BP, for instance those with 'white coat' hypertension, enabling more accurate screening and diagnosis.
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Didcot Health Centre, Didcot, Oxfordshire, UK.
D000328:Adult; D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001539:Bendroflumethiazide / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination / Q000379:methods*; D018660:Blood Pressure Monitoring, Ambulatory; D003971:Diastole / Q000187:drug effects; D004311:Double-Blind Method; D017292:Doxazosin / Q000627:therapeutic use; D004656:Enalapril / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013599:Systole / Q000187:drug effects; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D017311:Amlodipine; D001539:Bendroflumethiazide; D004656:Enalapril; D017292:Doxazosin