Relative value of beta blockers and thiazides for initiating antihypertensive therapy. Beta blockers or thiazides in hypertension. PLACEBO-CONTROLLED TRIAL OF ATENOLOL IN TREATMENT OF PREGNANCY-ASSOCIATED HYPERTENSION Beta-blockers versus diuretics in hypertensive men: main results from the HAPPHY trial. [Atenolol and bisoprolol in the treatment of mild and moderately severe hypertension]. The risk of myocardial infarction associated with antihypertensive drug therapies. Antihypertensive medications and C-reactive protein in the multi-ethnic study of atherosclerosis. Partial regression of vascular structural alterations in hypertensive patients treated with alpha-beta-blocker, labetalol. Effects of antihypertensive agents, alpha receptor blockers, beta blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and calcium channel blockers, on oxidative stress The International Prospective Primary Prevention Study in Hypertension (IPPPSH): Objectives and methods ACE inhibitors, beta-blockers, calcium blockers, and diuretics for the control of systolic hypertension. [The treatment of hypertension in the elderly using a beta-blocker: acebutolol (author's transl)]. Antihypertensive treatment in pregnancy: analysis of different responses to oxprenolol and methyldopa. BOPINDOLOL IN THE TREATMENT OF MODERATE HYPERTENSION: A DOSE‐RESPONSE STUDY The efficacy and tolerability of nebivolol in hypertensive African American patients. Obstetric aspects of the use in pregnancy-associated hypertension of the beta-adrenoceptor antagonist atenolol. Choices, persistence and adherence to antihypertensive agents: evidence from RAMQ data. First year of life after the use of atenolol in pregnancy associated hypertension. Reserpine plus hydrochlorothiazide and sotalol plus hydrochlorothiazide in Black and Indian hypertensive patients. Patterns of antihypertensive medication use in hemodialysis patients. Reduction of blood pressure and plasma triglycerides by omega‐3 fatty acids in treated hypertensives Long-term survival and use of antihypertensive medications in older persons. Nutritional dose of magnesium in hypertensive patients on beta blockers lowers systolic blood pressure: a double-blind, cross-over study. Beta-blockers do not impair the cardiovascular benefits of endurance training in hypertensives
Fifty-five patients with mild to moderate , renal or essential hypertension were admitted to a double blind cross-over trial of 18 weeks , involving treatment periods with placebo , the thiazide bendrofluazide ( 15 mg daily ) and the beta blocker atenolol ( 600 mg daily ) . Compared to the placebo period ( 190/117 mm Hg ) the hypotensive effect of atenolol ( -24/16 mm Hg ) was more pronounced than the hypotensive effect of bendrofluazide ( -17/6 mm Hg ) . Arguments in favor of initiating antihypertensive drug therapy with beta blocker were its more powerful hypotensive effect , the quicker onset of its action , less metabolic disturbance , decreased frequency of complaints and patient 's preference . On thiazides body weight and the frequency of swollen ankles decreased . Plasma renin concentration was not found to have a strong predicting power for the hypotensive effect of atenolol or bendrofluazide but low renin patients showed a more pronounced blood pressure decrease on bendrofluazide and high renin patients , especially essential hypertensives , on atenolol . While these points can be a guide to therapy today , the preference of one drug over the other must eventually be based on their relative efficacy in decreasing morbidity and mortality from the hypertensive disease Atenolol was compared with placebo in a r and omised and double-blind prospect i ve study of 120 women with mild to moderate pregnancy-associated hypertension who were also initially managed conventionally by bed rest .  Atenolol given once daily significantly reduced blood-pressure , prevented proteinuria , and reduced the number of hospital admissions . Loss of blood-pressure control leading to withdrawal from the study was commoner among the placebo group , whose babies had a high morbidity . Respiratory distress syndrome occurred only in the placebo group . Intrauterine growth retardation , neonatal hypoglycaemia , and hyperbilirubinaemia occurred with the same frequency in the two groups . Neonatal bradycardia was more common after atenolol but the systolic blood-pressure of the babies was the same in both groups . There was no difference between the groups in maternal symptoms which could have been attributed to beta-blocker therapy . Thus atenolol is more effective than conventional obstetric management in this form of hypertension and does not adversely affect mother or baby Men aged 40 - 64 years with mild to moderate hypertension [ diastolic blood pressure ( DBP ) 100 - 130 mmHg ] were r and omized to treatment with a  diuretic ( n = 3272 ) or a  beta-blocker ( n = 3297 ) , with additional drugs if necessary , to determine whether a beta-blocker based treatment differs from thiazide diuretic based treatment with regard to the prevention of coronary heart disease ( CHD ) events and death .  Patients with previous CHD , stroke or other serious diseases , or with contraindications to diuretics or beta-blockers were excluded . If normotension ( DBP less than 95 mmHg ) was not achieved by monotherapy , other antihypertensive drugs were added , but the two basic drugs were not crossed over . Patients were assessed at 6-monthly intervals . The mean follow-up for end-points was 45.1 months . Blood pressure ( BP ) side effects and end-points were recorded in a st and ardized manner . Entry characteristics and the BP reduction achieved were very similar in both treatment groups . All analyses were made on an intention-to-treat basis . The incidence of CHD did not differ between the two treatment groups . The incidence of fatal stroke tended to be lower in the beta-blocker treated group than in the diuretic treated group . Total mortality and the total number of end-points were similar in both groups . The percentage of patients withdrawn due to side effects was similar , whereas the number of reported symptoms , according to a question naire , was higher for patients on beta-blockers . The incidence of diabetes did not differ between the two groups . Subgroup analyses did not detect a difference in the effect of beta-blockers compared with diuretics in smokers as opposed to non-smokers , and beta-blockers also had the same effects as diuretics in the quartile with the highest predicted risk for CHD . Beta-blockers and thiazide diuretics were approximately equally well tolerated . The two drugs had a similar BP reducing effect although additional drugs had to be given more often in the diuretic group . Antihypertensive treatment based on a beta-blocker or on a thiazide diuretic could not be shown to affect the prevention of hypertensive complications , including CHD , to a different extent Atenolol and bisoprolol , two beta-1-selective blockers , were compared in patients with mild and medium severe hypertension . Forty patients with a diastolic blood pressure of 95 - 115 mm Hg were two weeks after discontinuation of treatment divided at r and om into two groups treated with 50 mg atenolol and 5 mg bisoprolol . If the blood pressure was not affected by this dosage , the dose was raised to 100 mg atenolol and 10 mg bisoprolol . The blood pressure readings , heart rate , side effects of the drugs , laboratory and echocardiographic values were followed up for a period of three months . The authors recorded a marked decline of pressure and heart rate after the first week of therapy , the pressure readings in an upright position did not differ statistically from values in a sitting position , orthostatic hypotension was not recorded . The rate of success of bisoprolol was 85 % , of atenolol 75 % . During treatment no serious side-effects were observed . The biochemical parameters and echocardiographic values were not altered significantly by treatment . Atenolol and bisoprolol are two effective beta-1-selective blockers with a comparable effect in the treatment of mild and medium severe hypertension . They are useful in monotherapy as well as in combination with other antihypertensive drugs . In hypertension associated with diabetes mellitus , incipient bronchopulmonary disease and pregnancy they are also indicated . They are well tolerated also by elderly patients , an advantage of bisoprolol may be that it has a smaller impact on pressure and heart rate during the night OBJECTIVE To assess the association between  first myocardial infa rct ion and the use of antihypertensive agents .  DESIGN AND SETTING We conducted a population -based case-control study among enrollees of the Group Health Cooperative of Puget Sound ( GHC ) . PATIENTS AND METHODS Cases were hypertensive patients who sustained a first fatal or nonfatal myocardial infa rct ion from 1986 through 1993 among women and from 1989 through 1993 among men . Controls were a stratified r and om sample of hypertensive GHC enrollees , frequency matched to the cases on age , sex , and calendar year . All 623 cases and 2032 controls had pharmacologically treated hypertension . Data collection included a review of the ambulatory medical record a brief telephone interview of consenting survivors . Antihypertensive therapy was assessed using the GHC 's computerized pharmacy data base . RESULTS The first analysis included only the 335 cases and 1395 controls initially free of cardiovascular disease . Compared with users of diuretics alone , the adjusted risk ratio of myocardial infa rct ion was increased by about 60 % among users of calcium channel blockers with or without diuretic ( risk ratio = 1.62 % ; 95 % confidence interval [ Cl ] , 1.11 to 2.34 ; P = .01 ) . The second analysis was restricted to 384 cases and 1108 controls who were taking either a calcium channel blocker or a beta-blocker .  Among these subjects , the use of calcium channel blockers compared with beta-blockers was associated with about a 60 % increase in the adjusted risk of myocardial infa rct ion ( risk ratio = 1.57 ; 95 % Cl , 1.21 to 2.04 ; P < .001 ) . While high doses of beta-blockers were associated with a decreased risk of myocardial infa rct ion ( trend P = .04 ) , high doses of calcium channel blockers were associated with an increased risk ( trend P < .01 ) . CONCLUSIONS In this study of hypertensive patients , the use of short-acting calcium channel blockers , especially in high doses , was associated with an increased risk of myocardial infa rct ion . Ongoing large-scale clinical trials will assess the effect of various antihypertensive therapies , including calcium channel blockers , on several important cardiovascular end points . Until these results are available , the findings of this study support the current guidelines from the Joint National Committee on the Detection , Evaluation and Treatment of High Blood Pressure that recommend diuretics and beta-blockers as first-line agents unless contraindicated , unacceptable , or not tolerated BACKGROUND The effects of different antihypertensive medication classes on C-reactive protein ( CRP ) levels are still not well characterized , and might be of relevance to treatment choices . METHODS We studied the association between antihypertensive medication class and CRP levels among participants with treated hypertension in the Multi-Ethnic Study of Atherosclerosis . We performed a cross-sectional study of hypertensive participants free of clinical cardiovascular disease who were taking one or more of the following medication classes : beta-blockers , calcium channel blockers , diuretics , and angiotensin-converting enzyme ( ACE ) inhibitors , or angiotensin II type I receptor blockers ( ARB ) .  RESULTS Among 2340 participants taking one or more antihypertensive medications , the mean serum CRP level was lower among participants taking a beta-blocker than among those not taking a beta-blocker ( 2.13 v 2.54 mg/L , P = .002 ) . This difference persisted after multivariate adjustment ( P = .021 ) . There were no other statistically significant differences in multivariate models . Among 1314 participants receiving monotherapy , the multivariate adjusted mean CRP level among participants taking a beta-blocker was lower ( 1.97 mg/L ) than those taking a diuretic ( 2.72 mg/L , P < .001 ) . In this monotherapy group , participants taking an ACE inhibitor or ARB also had a lower adjusted mean CRP ( 2.25 mg/L ) than those taking a diuretic ( P = .046 ) . African-American race/ethnicity did not modify any of those relationships . CONCLUSIONS The beta-blocker use was associated with lower CRP levels overall and among participants on monotherapy , whereas ACE inhibitor and ARB use was associated with lower CRP levels among participants on monotherapy . These findings warrant further evaluation in r and omized trials We studied the structural and functional characteristics of the vascular bed at calf level in 46 middle aged hypertensive patients ( 20 males and 26 females ) treated with different beta-blockers . After one week of placebo , the patients were divided into three groups : group 1 was treated with labetalol , an alpha-beta-blocker ( 200 mg t.t.d . ) ; group 2 was treated with acebutolol , a cardioselective beta-blocker with intrinsic sympathomimetic activity ( ISA ) ( 200 mg t.t.d . ) ; group 2 was treated with acebutolol , a cardioselective beta-blocker with intrinsic sympathomimetic activity ( ISA ) ( 200 mg t.t.d . ) ; group 3 was treated with metoprolol , a cardioselective beta-blocker without ISA ( 100 mg t.t.d . ) . Before and after placebo , and after three months of active drug treatment , we measured blood pressure , and rest and peak flow at the calf level by strain gauge plethysmography . Basal and minimal vascular resistances were calculated as the ratio between mean blood pressure and rest or peak flow , respectively . A significant decrease in blood pressure was observed in each group . However , basal and minimal vascular resistances decreased only in the labetalol-treated group . These observations indicate that antihypertensive agents that have similar effects on blood pressure , may have different effects on minimal vascular resistance . Therefore , maximum vasodilation of arterioles improves , suggesting that long term treatment with labetalol , but not with other beta-blockers is able to induce a partial regression of vascular structural alterations in hypertensive patients Background Free oxygen radicals and insufficiency of antioxidant enzymes have been implicated in the pathogenesis of hypertension disease ( HD ) . Trace elements function as a co-factor in antioxidant enzymes . The antioxidant system and trace elements have been investigated in many different studies including HD , but these subjects have not been investigated as a whole in these patients . Objective The aim of the present study was to investigate the antioxidative system and trace elements in hypertensive patients given different antihypertensive therapy .  Methods We examined  malondialdehyde and superoxide dismutase activities together with copper and zinc levels in plasma of 102 patients with HD and in 51 healthy controls . Results It was found that in patients with HD , plasma malondialdehyde was significantly higher than those of controls , while plasma superoxide dismutase activities were significantly lower in patients with HD . Plasma zinc levels were significantly higher than those of controls and plasma copper levels were significantly lower in patients with HD . Plasma lipid levels and oxidative state were analyzed in five different treatment groups given antihypertensive drug therapy before and after a 3-month treatment period . Conclusions In conclusion , our clinical study shows that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have notable effects on oxidative stress , and are an essential step in managing essential hypertension by the way of improvement of endothelial dysfunction . Although it has been shown that calcium channel blockers , beta blockers and alpha receptor blockers have antioxidant effects in in vitro conditions , we did not demonstrate these effects in our clinical study Summary The International Prospect i ve Primary Prevention Study in Hypertension ( IPPPSH ) , an international multicentre r and omised double-blind trial , compares antihypertensive regimens containing a beta-blocker ( oxprenolol ) with regimens not containing a beta-blocker . The protocol was developed and the study started in 1977 . 6,357 patients fulfilled the inclusion criteria and were enrolled by the end of 1980 . Patients have been treated in 6 countries for 3 to 5 years by 288 general practitioner and hospital out-patient centres . Follow-up was finished at the end of 1983 when 25,651 years of patient treatment had been completed . At entry patients had a diastolic pressure of 100–125 mmHg with no clinical evidence of cerebrovascular or ischaemic heart disease ( W.H.O. Stages I and II hypertension ) . The study was design ed to examine three main objectives : any influence of oxprenolol on the incidence of myocardial infa rct ion and sudden death compared with antihypertensive therapy not containing a beta-blocker ; the influence of cerebrovascular accidents in the same two groups ; a comparison of the antihypertensive effectiveness , and the subjective and objective tolerability of the regimens . This paper summarises the objectives and methodology , and examines r and omisation between the two treatment groups at entry into the IPPPSH The objective of this study was to determine which of the common groups of antihypertensive drugs is most effective at lowering systolic blood pressure ( SBP ) in elderly patients with previously untreated hypertension and the percentage of patients controlled with single or sequential monotherapy . Subjects were recruited from patients attending other outpatient clinics and entered into the study if their SBP was more than 150 mm Hg after three visits . Patients were given a low and high dose of each of the main classes of drugs or placebo for 1 month each . The study was a balanced , r and omized crossover design with five periods : placebo ; angiotensin converting enzyme inhibitors ; beta-blocking drugs ; calcium-blocking drugs ; and thiazide diuretics .  Blood pressure ( BP ) was measured 24 to 26 h after the previous dose . A question naire for side effects was administered at each visit . Seventy-four patients entered the study . beta-Blockers could not be used in 15 patients because of asthma or bronchospasm and these had two placebo periods . There were 9 of 66 patients on P , 9 of 46 on beta-blockers , 4 of 65 on calcium-blocking drugs , 4 of 65 on diuretic , and 1 of 62 patients on ACE inhibitors who did not progress to the higher dose because of side effects . Decreases in SBP compared to r and omized placebo were calcium-blocking drugs 15 mm Hg = diuretic 13 mm Hg > ACE inhibitors 8 mm Hg = beta-blockers 5 mm Hg . Blood pressure decrease correlated with placebo BP ( P < .0005 , r = 0.53 to 0.70 ) . When corrected for placebo , target SBP ( < 140 mm Hg ) was reached in between 6 % to 15 % of patients on monotherapy . Sequential monotherapy achieved target in 29 % . Angiotensin converting enzyme inhibitors , calcium-blocking drugs , and diuretics had no more side effects than placebo . Patients on beta-blockers had more side effects and the well-being score was reduced . Diuretics and calcium-blocking drugs are more effective in elderly patients at lowering SBP pressure . beta-Blockers were relatively ineffective , were frequently contraindicated , and had more side effects . Monotherapy achieved control in only a small number of patients . In elderly people with essential hypertension , therapy should be instituted with diuretics or calcium-blocking drugs , but combination therapy will usually be required to achieve goal The tolerance and antihypertensive action of acebutolol , as a sole drug and in combination with a diuretic , were studied in a population of 34 female subjects aged over 65 years , with a mean of 81 years , suffering from well tolerated essential hypertension . The study was carried out in the form of double blind permutations , each subject receiving successively in an order determined by r and om selection each of three therapeutic phases : acebutolol , acebutolol in combination with a diuretic and a placebo . The results showed that in the elderly acebutolol had a moderate diuretic action which was remarkably potentialised by diuretics . The tolerance of this beta-blocker was excellent : no cases of cardiac failure , and no disturbances in atrioventricular conduction developed during the phases with active treatment One hundred and eighty three hypertensive pregnant women were r and omly assigned to antihypertensive treatment with oxprenolol ( 96 women ) or methyldopa ( 87 women ) . Control of hypertension was equivalent in both treatment groups , and in 64 ( 35 % ) cases hydralazine had to be added to the treatment to achieve the therapeutic goal ( diastolic blood pressure below 85 mm Hg ) . Five perinatal deaths occurred , one in the oxprenolol group and four in the methyldopa group . Detailed analysis confirmed a previous report of greater fetal growth in the group treated with oxprenolol ; this trend was present regardless of severity of hypertension and parity . With increasing duration of treatment the differences between the two groups diminished , and there was no difference after 10 weeks of treatment , a finding that may explain some of the reported discrepancies among therapeutic studies . As hypertension in pregnancy may pursue an accelerated course , necessitating urgent delivery , and there is no satisfactory method of predicting the duration of treatment in individual patients fetal benefit is most likely to be achieved by treatment with oxprenolol , provided that there is no maternal contraindication to treatment with beta blockers Summary — To determine the optimal antihypertensive dose of bopindolol , we performed a r and omized double‐blind study in parallel groups . After 15 days of placebo single‐blind , 115 hypertensive patients received daily for 28 days one of 4 doses : 0 mg ( placebo ) , 0.5 mg , 1.0 mg , 2.0 mg . The reduction of supine diastolic blood pressure ( BP ) did not exhibit the pattern of a dose‐effect relationship . The effect of 0.5 mg belonged to the plateau of the dose‐effect curve ( P=0.1 , analysis of variance ) . The reduction of heart rate ( HR ) followed a typical dose‐effect curve , with a plateau beginning with 1 mg ( P = 0.02 ) . A trend toward an increase in the incidence of side‐effects with dosage was observed ( P=0.3 ) . Thus , the optimal antihypertensive dose may be 0.5 mg or less . Previous studies not using parallel r and omized groups suggested an antihypertensive dose ranging from 2 to 4 mg . This study confirms that the dose‐effect curves of beta blockers on HR and BP are dissociated . The dose‐effect curve of HR seems unsuitable for assessing the optimal antihypertensive dose of a beta blocker Hypertensive African Americans often respond poorly to beta-blocker monotherapy , compared with whites . There is evidence , however , that suggests that this response may be different if beta-blockers with vasodilating effects are used . This 12-week , multi-center , double-blind , r and omized placebo-controlled study assessed the antihypertensive efficacy and safety of nebivolol , a cardioselective , vasodilating beta1-blocker , at doses of 2.5 , 5 , 10 , 20 , or 40 mg once daily in 300 African American patients with stage I or II hypertension ( mean sitting diastolic blood pressure [ SiDBP ] > or = 95 mm Hg and < or = 109 mm Hg ) . The primary efficacy end point was the baseline-adjusted change in trough mean SiDBP . After 12 weeks , nebivolol significantly reduced least squares mean SiDBP ( P < or = .004 ) at all doses of 5 mg and higher and sitting systolic blood pressure ( P < or = .044 ) at all doses 10 mg and higher , compared with placebo . The drug was safe and well-tolerated , with no significant difference in the incidence of adverse events compared with placebo . Nebivolol monotherapy provides antihypertensive efficacy , with few significant adverse effects , in hypertensive African Americans The obstetric implication s of the use of the beta-adrenoceptor antagonist atenolol have been evaluated in a prospect i ve , r and omized , double-blind , and placebo-controlled study involving 120 women with pregnancy-associated hypertension . The clinical interpretation of antenatal and intrapartum cardiotocographs was uninfluenced by atenolol .  Human placental lactogen concentration fell in the atenolol group , but this was not an indicator of subsequent fetal distress . Other obstetric indices , such as urinary estriol excretion , were the same in both groups . Spontaneous premature labor occurred in five women receiving placebo but in none who received atenolol . Together with previously reported findings on pregnancy outcome , our study leads us to conclude that beta-blockers such as atenolol can appropriately be used in the management of hypertension during pregnancy BACKGROUND Most treatment recommendations for hypertension are based on criteria that consider efficacy , safety and cost . Given the need for long-term use of antihypertensive agents , treatment compliance should also be taken into consideration in the selection process . OBJECTIVE The purpose of the present study was to estimate persistence and adherence to  antihypertensive agents in a real-life setting . METHODS Persistence and adherence to treatment were estimated using data from the Regie de l'assurance maladie du Quebec . RESULTS Data from a r and om sample of 4561 subjects with a diagnosis of hypertension covered by the Regie de l'assurance maladie du Quebec drug plan and using one of the antihypertensive agents reimbursed by the drug plan for the first time between January 2000 and December 2001 were analyzed . The persistence rate observed after a two-year period with diuretics was significantly lower ( 52.8 % ) than with any other classes of antihypertensive agent ( P<0.01 ) . Persistence rates for beta-blockers , calcium channel blockers , angiotensin-II receptor blockers and angiotensin-I converting enzyme inhibitors were 69.3 % , 64.3 % , 60.9 % and 58.9 % , respectively . After two years , the proportion of patients who were 80 % adherent to their treatment was 64.9 % for angiotensin-I converting enzyme inhibitors , 65.0 % for angiotensin-II receptor blockers , 64.2 % for calcium channel blockers , 60.3 % for beta-blockers and 50.9 % for diuretics . The proportion of patients who were 80 % adherent to their treatment was significantly lower for diuretics than with any other antihypertensive agents ( P<0.01 ) . CONCLUSION Persistence and adherence to treatment are essential to treatment success . Results of the present study indicate that , in a real-life setting , patients are significantly less compliant to diuretics than to any other antihypertensive agents We describe the results of a prospect i ve study in which 120 women who developed hypertension in the last trimester of pregnancy were r and omly allocated in double blind manner to atenolol or placebo . The mean duration of treatment was five weeks . The only difference between groups during the neonatal period was in respiratory distress syndrome , mainly related to spontaneous premature labour , which occurred in six placebo group babies but in none from the atenolol group . Fifty five children from each group have been followed to 1 year of age . All in the atenolol group are developing normally but one child from the placebo group is brain damaged . These findings do not suggest any short or medium term paediatric complications after the use of beta blockers in pregnancy Fifty patients ( 25 Blacks and 25 Indians ) suffering from mild-to-moderate hypertension ( supine diastolic blood pressure 100 - 105 mmHg ) were studied in order to compare the antihypertensive effect of a combination of a beta-blocker ( sotalol hydrochloride 160 mg/d ) plus a thiazide derivative ( hydrochlorothiazide 25 mg/d ) ( Sotazide ; B-M ) with that of a combination of reserpine 0,1 mg/d ( Serpasil ; Ciba ) plus hydrochlorothiazide 25 mg/d ( Dichlotride ; Frosst MSD ) . The combination of reserpine plus hydrochlorothiazide was found to be as effective as that of sotalol plus hydrochlorothiazide in lowering the blood pressure in both the Black and the Indian patients . Two patients taking the combination containing reserpine developed side-effects , but this did not occur in any of those taking the combination containing sotalol . We feel that in developing countries , where the cost of therapy is important , reserpine in a dosage of less than 0,1 mg/d plus a thiazide derivative in low dosage is preferable to a beta-blocker plus a thiazide derivative in the treatment of hypertension PURPOSE Patterns of antihypertensive drug use in patients undergoing long-term hemodialysis therapy were studied . METHODS Patients attending seven outpatient hemodialysis units in Ohio were eligible for the study if they had been receiving the treatment for at least three months . Demographic and clinical data were obtained from patient interviews and computerized data bases , and blood pressure ( BP ) measurements were obtained before dialysis . Labeled names and dosages of antihypertensive drugs were recorded from containers the patients brought with them . Patients were asked to describe their adherence to the medications , their ability to afford the drugs , and their knowledge and beliefs about hypertension . Physical impairments in taking medication were also evaluated . RESULTS The frequency of hypertension was 89 % in the 270 participants . Antihypertensive drugs were prescribed for 76 % of the patients ; 25 % required three or more drugs . Hypertensive patients who were not receiving antihypertensive drugs ( 14 % ) had significantly higher BP than patients who were . Calcium-channel blockers were prescribed for 60 % of patients , angiotensin-converting-enzyme inhibitors for 33 % , and beta-blockers for 34 % . Eighty-three percent said the cost of drugs was never a problem , and 23 % said they sometimes forgot to take their medication . Almost all patients said they would not stop taking antihypertensive drugs if they were feeling better and agreed that monitoring BP was important . Twenty-two percent could not read the warning on a st and ard tablet container , and 12 % could not remove one tablet from the container . CONCLUSION Multidrug antihypertensive therapy was common among hemodialysis patients and was associated with significantly lower BP ; calcium-channel blockers were the most frequently prescribed agents . Most patients said they could afford drugs and reported good adherence to antihypertensive drug therapy Objective : To assess the effects of omega-3 ( n-3 ) fatty acid supplementation on blood pressure and plasma lipids in hypertensives treated with diuretics or beta-blockers . Design : Double-blind placebo-controlled cross-over trial consisting of a 4-week run-in phase and two 6-week intervention phases . Patients : A total of 43 patients of either sex taking a beta-blocker only ( n = 29 ) , a diuretic only ( n = 3 ) or a beta-blocker plus diuretic ( n=11 ) for hypertension were recruited from general practice . One patient from the latter group was withdrawn . Methods : Seated blood pressure was measured every 2 weeks in the clinic with a Dinamap . After the run-in phase , participants were r and omly assigned to take a supplement of either Omacor ( 85 % n-3 fatty acid concentrate ) or corn oil ( four 1-g capsules/day ) for 6 weeks , after which they crossed over to the other supplement . Fasted blood sample s were taken at the end of each phase for lipid analysis . Main outcome measures : The within-individual differences in systolic and diastolic pressure and plasma lipids  between Omacor and corn oil treatment . Results : Systolic/diastolic blood pressures measured during the run-in phase were normal ( 132±2/76±1 mmHg , n = 42 ) but decreased further with n-3 fatty acid supplementation . The mean within-individual difference in blood pressure compared with corn oil supplementation was 3.1 ± 1.0/1.8±0.6 mmHg ( P<0.01 ) . This was accompanied by a 21 % reduction in plasma triglycerides ( P < 0.01 ) and a 15 % increase in high-density lipoprotein-2 cholesterol ( P < 0.01 ) but there were no significant differences in total or low-density lipoprotein cholesterol . Conclusion : The antihypertensive and hypotriglyceridaemic effects of n-3 fatty acid supplementation seen in the present study suggest that it may be a useful adjunct to antihypertensive therapy with beta-blockers or diuretics OBJECTIVE To determine whether older persons with hypertension who use specific calcium antagonists and ACE inhibitors  have a different risk of mortality than those using beta-blockers . DESIGN A prospect i ve cohort study continuing from 1988 through 1992 . SETTING Three communities of the Established Population s for Epidemiologic Studies of the Elderly . PARTICIPANTS Hypertensive participants aged > or = 71 years ( n = 906 ) who had no evidence of congestive heart failure and who were using either beta-blockers ( n = 515 ) , verapamil ( n = 77 ) , diltiazem ( n = 92 ) , nifedipine ( n = 74 ) , or ACE inhibitors ( n = 148 ) .  Nifedipine was of the short acting variety . MEASUREMENTS The main outcome measure was all-cause mortality . Age , gender , smoking , HDL-cholesterol , blood pressure , intake of digoxin and diuretics , physical disability , self-perceived health , and comorbid conditions were examined as confounders . RESULTS During 3538 person-years of follow-up , 188 participants died ( 53 deaths per 1000 person-years ) . Compared with beta-blockers , after adjusting for age , gender , comorbid conditions and other health-related factors , the relative risks ( 95 % confidence interval ) for mortality associated with use of verapamil , diltiazem , nifedipine , and ACE inhibitors were 0.8 ( 0.4 - 1.4 ) , 1.3 ( 0.8 - 2.1 ) , 1.7 ( 1.1 - 2.7 ) , and 0.9 ( 0.6 - 1.4 ) , respectively . The results were unchanged after excluding participants with other potential contraindications to beta-blockers and after stratifying on coronary heart disease and use of diuretics . Higher doses of nifedipine were associated with higher mortality . CONCLUSION Compared with beta-blockers , use of short acting nifedipine was associated with decreased survival in older hypertensive persons . However , selective factors influencing the use of specific drugs in higher risk patients could not be completely discounted , and final conclusions will depend on clinical trials OBJECTIVES To evaluate if magnesium alters blood pressure in hypertensive patients treated with beta blockers and if such effect can be coupled to a change in potassium and magnesium levels in muscle , serum and urine . DESIGN A r and omized double-blind , cross-over study with magnesium and placebo taken orally , each for 8 weeks . SETTING Outpatient clinic , University Hospital , Umeå , Sweden . SUBJECTS Thirty-nine patients aged 26 - 69 years with moderate essential hypertension , treated before entry and during the study with continuous , unchanged beta blockers completed the study . INTERVENTIONS R and om allocation to receive magnesium aspartate or placebo . Daily magnesium dose was 15 mmol ( 365 mg ) distributed three times a day over 8 weeks . MAIN OUTCOME MEASURES Blood pressure , serum , urine and muscle magnesium and potassium . Measurements performed at the start , after 8 and 16 weeks . RESULTS Systolic supine and st and ing blood pressure significantly decreased when magnesium was supplemented following placebo but not when magnesium was given at start . When magnesium and placebo groups were independently compared there was no significant change in supine and st and ing systolic and diastolic pressure . Serum and urine magnesium and serum potassium were significantly higher after magnesium treatment , whilst no change was present in urine potassium or in muscle magnesium and potassium . CONCLUSIONS This study showed that 15 mmol magnesium day-1 given to mild to moderate hypertensive patients treated with beta blockers could be the cause of a significant decrease in supine and st and ing systolic blood pressure Aerobic physical exercise is broadly recommended as a helpful adjunct to obtain blood pressure control in hypertension . Beta-blockade interacts with heart rate , sympathetic tone , maximal workload and local lactate production . In the present r and omized-controlled study , we compared the cardiovascular effects of an endurance training programme in elderly hypertensives with or without beta-blockers and developed a first approach to determine a lactate-based training heart rate in presence of beta-blockade . Fifty-two patients ( 23 with beta-blocker , 29 without beta-blocker ) ⩾60 years with systolic 24-h ambulatory blood pressure ( ABP ) ⩾140 mm Hg and /or antihypertensive treatment were r and omly assigned to sedentary activity or a heart-rate controlled 12-week treadmill exercise programme ( lactate 2.0 mmol/l ) . In the exercise group , the training significantly decreased systolic and diastolic 24-h ABP , blood pressure on exertion ( 100 W ) and increased endothelium-dependent vasodilation ( flow-mediated vasodilation , FMD ) and physical performance both in the presence and absence of beta-blockade ( P<0.05 each ) . The extent of ABP reduction did not significantly differ in the presence or absence of beta-blockade ( Δ systolic ABP 10.6±10.5 vs 10.6±8.8 mm Hg , Δ diastolic ABP 5.7±8.6 vs 5.8±4.0 mm Hg ) . Mean training heart rate was significantly lower in the patients on beta-blockers ( 97.2±7.7 vs 118.3±7.5/min , P<0.001 ) . Lactate-based aerobic endurance training evokes comparable cardiovascular benefits in the presence and absence of beta-blockade including a marked improvement of endothelial function . In the present study , target training heart rate with beta-blockers is about 18 % lower than without
Beta-blockers appear to be no more effective and probably equally as safe .
It is unusual for women to change drugs due to side effects .
REVIEW ER 'S CONCLUSIONS Improvement in control of maternal blood pressure with use of beta-blockers would be worthwhile only if it were reflected in substantive benefits for mother and /or baby , and none have been clearly demonstrated .
Large r and omised trials are needed to determine whether antihypertensive therapy in general ( rather than beta-blocker therapy specifically ) results in greater benefit than risk , for treatment of mild-moderate pregnancy hypertension .
BACKGROUND Antihypertensives , such as beta-blockers , are used for pregnancy hypertension in the belief these will improve outcome for mother and baby .
OBJECTIVES To assess whether oral beta-blockers are better than placebo , or no beta-blocker , and have advantages over other antihypertensives , for women with mild to moderate pregnancy hypertension .