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Isradipine vs Propranolol in Hydrochlorothiazide-Treated Hypertensives: A Multicenter Evaluation

Isradipine vs Propranolol in Hydrochlorothiazide-Treated Hypertensives: A Multicenter Evaluation Abstract • A randomized, parallel, controlled study was conducted to evaluate the safety and efficacy of isradipine, 2.5 to 10 mg orally twice a day, compared with propranolol hydrochloride, 60 to 240 mg orally twice a day, in 78 hypertensives whose supine diastolic blood pressure was greater than 95 mm Hg while receiving 50 mg/d or more of hydrochlorothiazide. Isradipine or propranolol was titrated during a 10-week double-blind phase to achieve a supine diastolic blood pressure below 90 mm Hg while a fixed dose of hydrochlorothiazide was maintained. Supine diastolic blood pressure was reduced by 10 mm Hg in 88% of the isradipine/hydrochlorothiazide-treated and 83% of the propranolol/hydrochlorothiazide-treated groups and to less than 90 mm Hg in 55% of the isradipine/hydrochlorothiazide-treated and 69% of the propranolol/hydrochlorothiazide-treated patients. There was no significant difference in supine blood pressure reduction between either group, but there was a 3- to 4–beats per minute increase in supine heart rate in isradipine-treated patients and an expected 15- to 20–beats per minute decrease in heart rate in propranolol-treated patients. Five of 7 patients in the isradipine-treated group and 8 of 9 patients in the propranolol-treated group discontinued the therapy because of adverse reactions or treatment failure. Using Fisher's Exact Test, we found no significant difference in the relative frequency of individual adverse reactions between groups, although the absolute adverse reaction frequency was significantly higher with isradipine. This study demonstrates the effectiveness and safety of supplemental isradipine in the treatment of hypertension not controlled by hydrochlorothiazide alone. (Arch Intern Med. 1989;149:2453-2457) References 1. Nelson EB, Pool JL, Taylor AA. Antihypertensive activity of isradipine in humans: a new dihydropyridine calcium channel antagonist . Clin Pharmacol Ther . 1986;40:694-697.Crossref 2. Hamilton BP. Treatment of essential hypertension with PN 200-110 (isradipine) . Am J Cardiol . 1987;59:141B-145B.Crossref 3. Taylor SH, Jackson NC, Allen J, Pool PE. Efficacy of a new calcium antagonist PN 200-110 (isradipine) in angina pectoris . Am J Cardiol . 1987;59:123B-129B.Crossref 4. Greenberg B, Siemienczuk D, Broudy D. Hemodynamic effects of PN 200-110 (isradipine) in congestive heart failure . Am J Cardiol . 1987;59:70B-74B.Crossref 5. Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure. The 1984 report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med . 1984;144:1045-1057.Crossref 6. Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure. The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med . 1988;148:1023-1038.Crossref 7. Shepherd AMM, Carr AA, Davidov FM, et al. Efficacy and safety of isradipine in hypertension . J Cardiovasc Pharmacol . 1989;13:580-585.Crossref 8. Kirkendall WM. Comparative assessment of first-line agents for treatment of hypertension . Am J Med . 1988;84( (suppl 3B) ):32-41.Crossref 9. Winer N, Jacobs S, Kumar R. Evaluation of isradipine (PN 200-110) in mild to moderate hypertension . Clin Pharmacol Ther . 1987;42:442-448.Crossref 10. Dahlof B. Hemodynamic response, safety, and efficacy of isradipine in the treatment of essential hypertension . Am J Med . 1989;86( (suppl 4A) ):19-26.Crossref 11. Simonsen K. Dose-response relationship and incidence of adverse reactions with isradipine in patients with essential hypertension . Am J Med . 1989;86( (suppl 4A) ):91-93.Crossref 12. Taira N. Differences in cardiovascular profile among calcium antagonists . Am J Cardiol . 1987;59:24B-29B.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Isradipine vs Propranolol in Hydrochlorothiazide-Treated Hypertensives: A Multicenter Evaluation

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References (12)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1989.00390110049011
Publisher site
See Article on Publisher Site

Abstract

Abstract • A randomized, parallel, controlled study was conducted to evaluate the safety and efficacy of isradipine, 2.5 to 10 mg orally twice a day, compared with propranolol hydrochloride, 60 to 240 mg orally twice a day, in 78 hypertensives whose supine diastolic blood pressure was greater than 95 mm Hg while receiving 50 mg/d or more of hydrochlorothiazide. Isradipine or propranolol was titrated during a 10-week double-blind phase to achieve a supine diastolic blood pressure below 90 mm Hg while a fixed dose of hydrochlorothiazide was maintained. Supine diastolic blood pressure was reduced by 10 mm Hg in 88% of the isradipine/hydrochlorothiazide-treated and 83% of the propranolol/hydrochlorothiazide-treated groups and to less than 90 mm Hg in 55% of the isradipine/hydrochlorothiazide-treated and 69% of the propranolol/hydrochlorothiazide-treated patients. There was no significant difference in supine blood pressure reduction between either group, but there was a 3- to 4–beats per minute increase in supine heart rate in isradipine-treated patients and an expected 15- to 20–beats per minute decrease in heart rate in propranolol-treated patients. Five of 7 patients in the isradipine-treated group and 8 of 9 patients in the propranolol-treated group discontinued the therapy because of adverse reactions or treatment failure. Using Fisher's Exact Test, we found no significant difference in the relative frequency of individual adverse reactions between groups, although the absolute adverse reaction frequency was significantly higher with isradipine. This study demonstrates the effectiveness and safety of supplemental isradipine in the treatment of hypertension not controlled by hydrochlorothiazide alone. (Arch Intern Med. 1989;149:2453-2457) References 1. Nelson EB, Pool JL, Taylor AA. Antihypertensive activity of isradipine in humans: a new dihydropyridine calcium channel antagonist . Clin Pharmacol Ther . 1986;40:694-697.Crossref 2. Hamilton BP. Treatment of essential hypertension with PN 200-110 (isradipine) . Am J Cardiol . 1987;59:141B-145B.Crossref 3. Taylor SH, Jackson NC, Allen J, Pool PE. Efficacy of a new calcium antagonist PN 200-110 (isradipine) in angina pectoris . Am J Cardiol . 1987;59:123B-129B.Crossref 4. Greenberg B, Siemienczuk D, Broudy D. Hemodynamic effects of PN 200-110 (isradipine) in congestive heart failure . Am J Cardiol . 1987;59:70B-74B.Crossref 5. Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure. The 1984 report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med . 1984;144:1045-1057.Crossref 6. Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure. The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med . 1988;148:1023-1038.Crossref 7. Shepherd AMM, Carr AA, Davidov FM, et al. Efficacy and safety of isradipine in hypertension . J Cardiovasc Pharmacol . 1989;13:580-585.Crossref 8. Kirkendall WM. Comparative assessment of first-line agents for treatment of hypertension . Am J Med . 1988;84( (suppl 3B) ):32-41.Crossref 9. Winer N, Jacobs S, Kumar R. Evaluation of isradipine (PN 200-110) in mild to moderate hypertension . Clin Pharmacol Ther . 1987;42:442-448.Crossref 10. Dahlof B. Hemodynamic response, safety, and efficacy of isradipine in the treatment of essential hypertension . Am J Med . 1989;86( (suppl 4A) ):19-26.Crossref 11. Simonsen K. Dose-response relationship and incidence of adverse reactions with isradipine in patients with essential hypertension . Am J Med . 1989;86( (suppl 4A) ):91-93.Crossref 12. Taira N. Differences in cardiovascular profile among calcium antagonists . Am J Cardiol . 1987;59:24B-29B.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1989

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