Safety and antihypertensive efficacy of carvedilol and atenolol alone and in combination with hydrochlorothiazide

Abstract

Carvedilol has been shown to be effective and safe in patients with essential hypertension when given as monotherapy. In this double-blind, randomized, group-comparative study, 2 groups of 59 patients with mild to moderate essential hypertension [median supine systolic/diastolic blood pressure at baseline (SBP/DBP), 168/105 mmHg] were treated with either 25 mg carvedilol once daily (o.d.) or 50 mg atenolol o.d. for 4 weeks. Responders at 4 weeks (DBP, less than 90 mmHg) terminated the study. Nonresponders continued the study. Hydrochlorothiazide (HCTZ) was added at 25 mg o.d. for a further 6 weeks. The median blood pressure decreased under monotherapy with carvedilol (n = 59) from 167/105 at baseline to 155/94 mmHg after 4 weeks, and in the atenolol group (n = 59) it decreased from 168/105 to 162/97 mmHg. The patients who received carvedilol in combination with HCTZ and were evaluated for efficacy (n = 38) showed a decrease in SBP/DBP from 156/97 at the end of monotherapy to 145/88 mmHg after 10 weeks; the combination of atenolol with HCTZ (n = 44) reduced BP from 162/97 to 147/88. Both carvedilol and atenolol were safe when given either alone or in combination with HCTZ. In conclusion, after long-term administration, 25 mg carvedilol o.d. and 50 mg atenolol o.d. significantly reduced both SBP and DBP over 24 h. The addition of HCTZ led to a further increase in antihypertensive efficacy. Combined treatment with carvedilol or atenolol and HCTZ was very well tolerated, without hypotensive events or relevant changes in objective safety parameters.