Atenolol and bendrofluazide in hypertension. ACE inhibitors, beta-blockers, calcium blockers, and diuretics for the control of systolic hypertension. Partial regression of vascular structural alterations in hypertensive patients treated with alpha-beta-blocker, labetalol. Mindfulness-based stress reduction and physiological activity during acute stress: a randomized controlled trial. Antihypertensive efficacy and side effects of three beta‐blockers and a diuretic in elderly hypertensives: a report from the STOP‐Hypertension study Beta-blockers versus diuretics in hypertensive men: main results from the HAPPHY trial. Efficacy of candesartan cilexetil as add-on therapy in hypertensive patients uncontrolled on background therapy: a clinical experience trial. ACTION Study Investigators. [Renal hemodynamics and proteinuria in chronic glomerulonephritis treated with beta-receptor blockers or ace inhibitors]. Beta-blockers do not impair the cardiovascular benefits of endurance training in hypertensives Effects of landiolol, a short-acting beta-1 blocker, on hemodynamic variables during emergence from anesthesia and tracheal extubation in elderly patients with and without hypertension A 16-week, randomized, double-blind, placebo-controlled, crossover trial to quantify the combined effect of an angiotensin-converting enzyme inhibitor and a beta-blocker on blood pressure reduction. Nutritional dose of magnesium in hypertensive patients on beta blockers lowers systolic blood pressure: a double-blind, cross-over study. [Efficacy of monotherapy with 15 antihypertensive agents in treating essential hypertension assessed by 24-hour ambulatory blood pressure monitoring]. Hemodynamics of metoprolol and pindolol in systemic hypertension with particular reference to reversal of structural vascular changes. To compare the effect of Telmisartan with Metoprolol on arterial stiffness in hypertension: prospective randomized parallel group trial. Effects of nebivolol or irbesartan in combination with hydrochlorothiazide on vascular functions in newly-diagnosed hypertensive patients: the NINFE (Nebivololo, Irbesartan Nella Funzione Endoteliale) study. Beta-adrenergic blocking agents in the treatment of pregnancy-induced hypertension. Plasma renin and the antihypertensive effect of the orally active renin inhibitor aliskiren in clinical hypertension. The effects of nonsteroidal anti-inflammatory drugs on blood pressures of patients with hypertension controlled by verapamil. Behavioral and physiological effects of a beta blocker and relaxation therapy on mild hypertensives. Comparison of celiprolol and propranolol in stable angina pectoris. Celiprolol International Angina Study Group. [Esmolol as a bolus for prevention of sympathetic adrenergic reactions following induction of anesthesia]. Plasma renin activity predicts blood pressure responses to beta-blocker and thiazide diuretic as monotherapy and add-on therapy for hypertension.
The effect of atenolol , a new beta-1-adrenergic receptor blocking agent , was studied in a double-blind cross-over trial in 24 carefully selected hypertensive out patients . After a four-week run-in period on matching placebo each patient received atenolol 200 mg/day , atenolol 400 mg/day , a combination of atenolol 200/mg day with bendrofluazide 5 mg/day , and bendrofluazide 5 mg/day alone , according to a r and om sequence . Atenolol at either dose produced a significantly greater reduction in all blood pressure levels except st and ing systolic pressure than bendrofluazide alone . There was no statistically significant difference between the effects of the two atenolol doses on either blood pressure or pulse rate . The addition of bendrofluazide to atenolol result ed in a further significant lowering of the blood pressure . A significant effect of thiazide on weight was noted . The study shows that atenolol , a cardioselective beta-blocker of similar potency to propranolol in animals but without membrane-stabilizing or partial agonist acitivity , is an effective and well-tolerated hypotensive agent 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 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 OBJECTIVE The aim was to examine the effects of a Mindfulness-Based Stress Reduction ( MBSR ) intervention on cardiovascular and cortisol activity during acute stress . METHOD Eighty-eight healthy community-dwelling individuals reporting elevated stress levels were r and omly assigned to the MBSR protocol or a waitlist control group . Before and after the intervention period they participated in a laboratory stress protocol consisting of mental arithmetic and speech tasks . Laboratory measurements included continuous cardiovascular parameters ( heart period , heart rate variability , and systolic and diastolic blood pressure [ SBP and DBP ] ) , and salivary cortisol . RESULTS Compared to the control group and controlling for age , sex , body mass index , and beta-blockers , the MBSR group showed larger pre- to postintervention decreases in overall SBP ( F(1 , 58 ) = 4.99 , p = .029 , partial η² = .08 ) and DBP ( F(1 , 58 ) = 11.09 , p = .002 , partial η² = .16 ) . In addition , the MBSR group exhibited smaller SBP and DBP stress-related changes from pre- to postintervention ( F(2 , 116 ) = 4.89 , p = .012 , partial η² = .08 ; F(2 , 116 ) = 6.07 , p = .007 , partial η² = .10 , respectively ) . No effects were obtained on other physiological measures . CONCLUSION MBSR may help reducing blood pressure levels and blood pressure reactivity to stress Objective : To compare the blood pressure‐lowering efficacy , the frequency of side effects and changes in laboratory values of three & bgr;‐blockers and a potassium‐sparing diuretic combination in elderly hypertensive patients . Design : The Swedish Trial in Old Patients with Hypertension ( STOP‐Hypertension ) was a prospect i ve , r and omized , double‐blind , multicentre trial comparing active antihypertensive treatment with placebo in patients aged 70‐84 years . Methods : The study group consisted of 1627 elderly hypertensive patients ( mean ± SD age 75.7 ± 3.7 years ; 37 % males , 63 % females ) . Supine and st and ing blood pressure , heart rate and side effects were recorded at each visit . Blood was drawn for routine analysis . The mean length of follow‐up was 25 months ( range 6‐65 ) . No patient was lost to follow‐up . Results : After 2‐months ' single‐drug therapy , all four active drugs were found to be equally effective in reducing diastolic blood pressure ( DBP ) . However , there were differences in their efficacy in reducing systolic blood pressure ( SBP ) ; the diuretic was significantly more effective than the & bgr;‐receptor blockers . The results of a series of multiple linear regression analyses showed that the observed differences in effect on SBP could not be explained by the different effects of the drugs on heart rate . More than two‐thirds of the patients were given supplementary treatment , most of them already by the 2‐month visit , after which there was no significant difference in blood pressure among the treatment regimens . The changes in laboratory values and in the prevalence of symptoms were minor for all four regimens . Conclusion : Metoprolol ( controlled release ) , atenolol , pindolol and the combination hydrochlorothiazide + amiloride were equally effective as single drugs in reducing DBP . There were differences in their efficacy in reducing SBP , the diuretic being more effective than the & bgr;‐blockers . After addition of supplementary treatment ( & bgr;‐blocker to diuretic , or vice versa ) there were no significant differences in blood pressure reduction among the groups . The changes in laboratory values and in the prevalence of symptoms were minor for all active treatment regimens . Thus , the satisfactory effect on cardiovascular morbidity and mortality was not impaired by low tolerability of the drugs 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 A large-scale , 8-week , open-label , clinical experience trial evaluated the efficacy of the angiotensin II receptor ( AT1 subtype ) blocker c and esartan cilexetil ( 16 to 32 mg once daily ) either alone or as add-on therapy in 6465 hypertensive patients . The study population was 52 % female and 16 % African American with a mean age of 58 years . It included 5,446 patients who had essential hypertension ( HBP ) and 1,014 patients who had isolated systolic hypertension ( ISH ) . These patients had either untreated or uncontrolled hypertension ( systolic blood pressure [ SBP ] 140 to 179 mm Hg or diastolic blood pressure [ DBP ] 90 to 109 mm Hg inclusive at baseline ) despite a variety of antihypertensive medications including diuretics , calcium antagonists , angiotensin converting enzyme ( ACE ) inhibitors , and alpha- or beta-blockers , either singly or in combination . The mean baseline blood pressure for the HBP group was 156/97 mm Hg . C and esartan cilexetil as monotherapy ( in 51 % of HBP patients ) reduced mean SBP/DBP by 18.7/ 13.1 mm Hg . As add-on therapy ( in 49 % of HBP patients ) to various background therapies , c and esartan cilexetil consistently reduced mean SBP/DBP further , irrespective of the background therapy : diuretics ( 17.8/11.3 mm Hg ) , calcium antagonists ( 16.6/11.2 mm Hg ) , beta-blockers ( 16.5/ 10.4 mm Hg ) , ACE inhibitors ( 15.3/10.0 mm Hg ) , alpha-blockers ( 16.4/10.4 mm Hg ) . The mean baseline blood pressure for the ISH group was 158/81 mm Hg . C and esartan cilexetil , as monotherapy ( in 34 % of ISH patients ) , reduced SBP/DBP by 17.0/4.4 mm Hg . As add-on therapy ( in 66 % of ISH patients ) to various background therapies , c and esartan cilexetil consistently reduced mean SBP/DBP further , irrespective of the background therapy : diuretics ( 17.4/5.1 mm Hg ) , calcium antagonists ( 15.6/3.6 mm Hg ) , beta-blockers ( 14.0/4.8 mm Hg ) , ACE inhibitors ( 13.4/4.3 mm Hg ) , and alpha-blockers ( 11.6/4.5 mm Hg ) . The further blood pressure lowering effects of c and esartan cilexetil as add-on therapy were seen regardless of age , sex , and race . Overall , 6.8 % of the 6465 patients withdrew because of adverse events , most commonly headache ( 6.3 % ) and dizziness ( 5.0 % ) . Orthostatic hypotension was infrequent ; 0.2 % with c and esartan cilexetil alone , and 0.8 % with c and esartan cilexetil as add-on therapy . Thus , c and esartan cilexetil either alone or as add-on therapy was highly effective for the control of systolic or diastolic hypertension regardless of demographic background when used in typical clinical practice setting BACKGROUND AND OBJECTIVE In patients with chronic glomerular nephropathy associated arterial hypertension and proteinuria are considered to be cardinal risk factors in the progressive deterioration of renal function . Treatment regimens which reduce proteinuria and hypertension improve prognosis . The effect of the new beta-receptor blockers compared to common ACE-Inhibitors is of special interest . PATIENTS AND METHODS The studied cohort consisted of 11 patients with CGN , hypertension and proteinuria > 400 mg/24 h. Four drugs were given for 4 weeks , doubly blinded and r and omized according to a " Latin-square design " : Celiprolol ( beta-1-antagonist , beta-2-agonist , 200 mg/d ) , Atenolol ( selective beta-1-antagonist , 50 mg/d ) , Ramipril ( ACE-inhibitor , 2.5 mg/d ) and placebo . There was a two-week wash-out phase between each of the four treatment phases . At the end of each treatment phase glomerular filtration rate ( GFR ) and effective renal plasma flow ( ERPF ) were measured by inulin and para-amino-hippuric acid ( PAH ) clearance . Proteinuria was determined in the course of a three-day collection period at the end of each treatment phase . During this period blood pressures were measured with a continuous 24-hour blood pressure monitor . RESULTS Mean arterial blood pressure ( MAP ) was significantly reduced , compared with placebo , by all three antihypertensives ( 108 + /- 9 mm Hg with placebo , 98 + /- 12 mg Hg with atenolol , 101 + /- 11 mm Hg with celiprolol and 98 + /- 8 mm Hg with ramipril ; P < 0.01 ) . Celiprolol produced a significant rise In ERPF ( 322 + /- 109 ml/min with placebo , 391 + /- 110 ml/min with celiprolol : P < 0.05 ) . GFR was slightly , but not significantly , reduced by celiprolol and atenolol .  Filtration fraction remained unchanged with atenolol and celiprolol , while it was slightly , but not significantly , reduced with ramipril . Compared with the placebo , all three drugs significantly reduced proteinuria ( P < 0.05 ) : 1.8 + /- 1.3 g/24 h with placebo , 1.2 + /- 1.2 g/24 h with atenolol , 1.2 + /- 1.1 g/24 h with celiprolol and 1.4 + /- 1.4 g/24 h with ramipril . CONCLUSION These data indicate that , in addition to ACE inhibitors , the new generation of beta-receptor blockers in particular , because of their vasodilator action , favourably influence proteinuria and renal blood flow in patients with CGN and arterial hypertension 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 Purpose Tracheal extubation and emergence procedures induce abrupt changes in hemodynamics and humoral responses . We conducted a prospect i ve r and omized study to examine the effects of the short-acting beta-1 blocker , l and iolol , on hemodynamics during emergence from anesthesia in elderly patients with and without hypertension . Methods Thirty-one hypertensive and 32 normotensive elderly patients were r and omly divided into two groups : a control ( placebo group ) and a l and iolol infusion group . L and iolol was dissolved in 20 ml of saline and administered as an infusion at the rate of 0.125 mg·kg−1·min−1 for 1 min and then decreased to 0.04 mg·kg−1·min−1 until extubation . Control patients received an equal volume of saline . Heart rate and blood pressure were recorded every minute from immediately before the administration of l and iolol up to the discontinuation of l and iolol , and every 5 min from the discontinuation of l and iolol to 30 min after termination of the infusion . Results Systolic blood pressure in the control group patients with hypertension increased during anesthesia emergence and tracheal extubation , as did the heart rate . L and iolol infusion in the elderly patients with hypertension partially prevented the increase in systolic blood pressure and completely prevented the increase in heart rate associated with emergence from anesthesia . L and iolol infusion in the elderly patients without hypertension brought about a decrease in heart rate during emergence and tracheal extubation . Conclusion This study indicates that the use of a l and iolol infusion for preventing hemodynamic instability in elderly patients during the emergence period would be dependent on the presence or absence of hypertension in these patients BACKGROUND Although beta-blockers and angiotensin-converting enzyme ( ACE ) inhibitors are often used together , there is a lack of quantitative evidence for the efficacy of this combination in reducing  blood pressure ( BP ) .  OBJECTIVE The aim of this r and omized , double-blind , placebo-controlled , crossover study was to quantify the combined effect of a beta-blocker ( atenolol ) and an ACE inhibitor ( lisinopril ) in lowering BP . METHODS Participants who were > or = 40 years of age and enrolled in the hypertension or anticoagulation clinics at St. Bartholomew 's Hospital , London , United Kingdom , were r and omized to 3 consecutive 4-week treatments consisting of atenolol 25 mg plus placebo , lisinopril 5 mg plus placebo , and atenolol 25 mg plus lisinopril 5 mg , plus a period of 2 placebos . At the end of each period , seated BP was measured in the right arm using electronic monitors . RESULTS The mean  placebo-adjusted peak BP reductions among the 47 participants ( mean age , 62 [ range 42 - 82 ] years ; 75 % male ; 70 % white/30 % Asian ; mean baseline BP , 145/82 mm Hg ) who completed all 4 periods were significantly greater with the combination of both drugs than with either drug alone ( P < 0.001 ) . The systolic reductions were 22.9 mm Hg with combination treatment , 16.1 mm Hg with atenolol treatment , and 12.5 mm Hg with lisinopril treatment , and the diastolic reductions were 13.9 , 9.8 , and 6.8 mm Hg , respectively . The BP-lowering effect of the 2 drugs together was similar to that expected from the sum of each alone , allowing for the reduced effect of 1 drug given the lower pretreatment BP due to the other . The incremental systolic BP reduction from the 2 drugs together compared with 1 alone was 79 % ( 95 % CI , 54%-126 % ) of the expected additive effect , 88 % ( 95 % CI , 58%-130 % ) for diastolic BP , and 84 % ( 95 % CI , 65%-118 % ) for the mean of systolic and diastolic BP . CONCLUSIONS The combination of the beta-blocker atenolol 25 mg plus the ACE inhibitor lisinopril 5 mg was associated with a significantly greater decrease in BP compared with either alone . The BP reduction with the combination treatment was similar to and statistically consistent with the 2 drugs having additive effects . Clinical Trials Identification Number : IS RCT N97280940 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 OBJECTIVE To evaluate the efficacy of the monotherapy of 15 agents in treating essential hypertension . METHODS After 2-week wash-out , a total of 370 patients with seated diastolic blood pressure 95 - 114 mmHg and seated systolic blood pressure < 180 mmHg were r and omized to different therapeutic groups .  24-hour ambulatory blood pressure monitoring was performed before medication and at the end of 8 weeks . RESULT All the agents significantly reduced the 24 hour mean blood pressures after treatment except doxazosin , terazosin , and torasemide . CONCLUSION The result suggested that the angiotensin-converting enzyme inhibitors , angiotensin II receptor blockers , beta-blockers and long-acting calcium antagonists were effective in treating essential hypertension , while the low-dose doxazosin , terazosin and torasemide can be used for combination therapy but not for monotherapy In a double-blind , comparative study metoprolol ( 100 to 300 mg/day ) or pindolol ( 5 to 15 mg/day ) was given in r and omized order to 39 patients with uncomplicated essential hypertension .  Peripheral hemodynamics were studied by noninvasive means after an initial 6-week placebo period and again after 6 weeks and 6 months of active treatment . Three patients withdrew from the trial during the 6-week period of active treatment .  Heart rate during exercise on an ergometric bicycle to a predetermined workload indicated that the degree of beta-adrenoceptor blockade was identical during treatment with either metoprolol or pindolol . Both agents also reduced resting blood pressure to the same extent . Heart rate at rest fell considerably more during metoprolol than pindolol therapy , while vascular resistance was reduced by pindolol but not by metoprolol . This indicates that the antihypertensive effect of metoprolol can be ascribed mainly to cardiac mechanisms ; in contrast , pindolol appears to lower blood pressure primarily through vascular effects . Studies at maximal dilatation showed that pindolol , but not metoprolol , reduced resistance at maximal dilatation after 6 months of treatment , indicating that a reversal of the structural vascular changes had occurred . The hemodynamic differences between the 2 agents can probably be explained by the fact that pindolol with its intrinsic sympathomimetic activity acts as a partial agonist causing active stimulation of vascular beta 2 adrenoceptors and relaxation of resistance vessels BACKGROUND Hypertension is often complicated by increased arterial stiffness and is an independent predictor of adverse cardiovascular ( CV ) outcome . Beta blockers and angiotensin receptor blockers ( ARBs ) are commonly used antihypertensive agents . The effect of beta blockers and ARBs on arterial stiffness has not been compared adequately . The aim of the present study is to compare the effect of telmisartan with metoprolol on arterial stiffness in hypertensive patients in prospect i ve open label r and omized parallel group intervention study . METHODS 100 patients of hypertension , not on any antihypertensive agents , were enrolled after obtaining informed consent . Baseline recording of data related to demographics , CV risk factors , anthropometry and BP were made . Arterial stiffness was measured noninvasively by recording pulse wave velocity ( PWV ) using periscope ( Genesis medical system ) . Left ventricular ( LV ) mass was measured using 2D guided M-mode echocardiography . Blood sugar , renal function , lipids and uric acid estimations were done in fasting state . Patients were r and omized to receive metoprolol and telmisartan using stratified r and omization technique . Dose of the study drugs were titrated to achieve target BP of < 140/90 mmHg . Data related to PWV , BP , anthropometry and blood biochemistry was repeated after 6 months of treatment with study drugs . RESULTS Telmisartan result ed in significantly greater reduction in arterial stiffness index ( ASI ) in left and right lower limb arterial bed ( 39.9 ± 11.7 vs. 46.8 ± 17.0 m/s , p < 0.02 ) and ( 36.4 ± 9.6 vs. 44.86 ± 15.1 m/s , p < 0.002 ) respectively and systolic blood pressure ( SBP ) ( -4.9 mmHg with 95 % C.I. of -8.0 - 1.7 mmHg , p < 0.003 ) compared to metoprolol . Reduction in diastolic blood pressure ( DBP ) in telmisartan and metoprolol groups was not different statistically ( -1.0 mmHg with 95 % C.I. of -3.3 - 1.2 mmHg , p < 0.3 ) . The change in LV mass was not significantly different between the study groups ( 135.5 ± 37.6 vs. 143.2 ± 41.5 , p < 0.3 ) BACKGROUND Arterial hypertension affects endothelial function and arterial stiffness . The angiotensin ( AT1 ) receptor antagonist irbesartan improves endothelial function and arterial stiffness in hypertensive patients .  Nebivolol , a beta(1)-selective beta blocker , reduces systemic vascular resistance and stimulates nitric oxide release thus exerting positive effects on vascular function . However , comparative studies on the vascular effects of third generation beta-blockers and AT1 receptor blockers are lacking . Aim of this r and omized , double-blind study was to test the hypothesis of non-inferiority of nebivolol to irbesartan , both in association with hydrochlorothiazide , on endothelial function , arterial stiffness and central hemodynamic parameters in patients with arterial hypertension naïve on therapy . METHODS Sixty-five patients were r and omized to receive irbesartan/hydrochlorothiazide ( 150 mg/12.5 mg day ) or nebivolol/hydrochlorothiazide ( 5mg/12.5 mg day ) for 8-weeks . Endothelial function , pulse wave velocity , augmentation index , central and brachial blood pressures were measured at baseline and at the end of the study . RESULTS Systolic and diastolic central blood pressure , as well as brachial arterial pressure , decreased to a similar extent after both treatments . Similar changes in endothelial function between groups were detected at the end of the study . A significant reduction in pulse wave velocity , central blood pressure , and augmentation index adjusted for heart rate , was found in both the treatment groups at the end of the study , without significant differences between groups . CONCLUSIONS The results of this study confirm the hypothesis of non-inferiority of short-term treatment with nebivolol compared to irbesartan , both in association with hydrochlorothiazide , on endothelial function , arterial stiffness and central hemodynamic parameters in hypertensive patients naïve on therapy Fifty-one women with pregnancy-induced hypertension ( PIH ) were r and omly allocated to one of three treatment groups : A : hydralazine ( 13 ) ; B : hydralazine and propranolol ( 17 ) ; and C : hydralazine and pindolol ( 19 ) . All women fulfilled the pretreatment criteria and were of similar age , numbers of previous pregnancies and had systolic blood pressure ( SBP ) of between 140 and 160 mmHg and diastolic blood pressure ( DBP ) of between 95 and 110 mmHg .  Hypertension was treated equally well by all three regimens ( mean SBP was 133.6 , 130 and 134 mmHg , respectively ) . Heart rate was significantly higher than baseline in group A and lower in groups B and C , as is to be expected with beta-blocker treatment . Side-effects were more frequent in group A than in groups B and C , 62 % of the patients on hydralazine monotherapy complained of palpitations compared to 35 % on combination treatment . Fetal outcome differed in the various groups . Birth weight was significantly lower in group B , where regimen included propranolol , compared to that of group C , for whom the regimen included pindolol ( 3,044.7 + /- 443.8 and 2,709.6 + /- 485.5 gm , p < 0.05 ) . Mean blood glucose of the newborns were similar in groups A and C ( 76.5 + /- 16.5 and 78.6 + /- 15 gm% ) and significantly lower in group B ( 62.6 + /- 14 gm% , p < 0.02 ) . In conclusion , blood pressure was equally well treated in all three treatment groups . However , more maternal side-effects occurred in group A , the group treated with hydralazine monotherapy , while propranolol in combination with hydrazaline ( group B ) had some negative effects on fetal development which did not occur in pindolol/hydrazaline combination BACKGROUND Aliskiren is the first in a new class of orally effective renin inhibitors for the treatment of hypertension . METHODS In 569 patients with mild-to-moderate hypertension , blood pressure ( BP ) , plasma renin activity ( PRA ) and plasma renin concentration ( PRC ) were measured before and after 8 weeks of double-blind treatment with once-daily oral doses of aliskiren ( 150 , 300 or 600 mg ) , irbesartan 150 mg or placebo . RESULTS Aliskiren 150 , 300 and 600 mg and irbesartan 150 mg significantly reduced mean cuff sitting systolic BP ( SBP ) from baseline ( p < 0.001 vs. placebo ) . Aliskiren 150 , 300 and 600 mg significantly reduced geometric mean PRA by 69 % , 71 % and 75 % from baseline respectively ( p < 0.05 vs. placebo ) . Irbesartan 150 mg significantly increased PRA by 109 % ( p < 0.05 vs. placebo ) . Aliskiren dose-dependently increased PRC from baseline by 157 % , 246 % and 497 % , at 150 , 300 and 600 mg respectively , compared with a 9 % decrease with placebo ( p < 0.05 ) . PRC increased significantly more with aliskiren 300 and 600 mg compared with irbesartan 150 mg ( 105 % ; p < 0.05 ) . Regression analysis showed no significant correlations between baseline PRA and changes in SBP in any of the treatment groups , but interestingly , the slopes of the regression lines between changes in SBP and log-transformed baseline PRA were + 2.0 for placebo and -1.5 , -1.8 and -2.3 for aliskiren 150 , 300 and 600 mg respectively . The slope for irbesartan 150 mg ( -1.4 ) was similar to that for aliskiren 150 mg . CONCLUSIONS Aliskiren reduces SBP and PRA and increases PRC dose-dependently . In contrast , irbesartan reduces SBP but increases both PRC and PRA . As PRA is a measurement of angiotensin I-generating capacity , PRA can be used for measuring the ability of an antihypertensive agent to prevent the generation or action of Ang II , either directly ( renin inhibitors , beta-blockers , central alpha(2)-agonists ) or indirectly ( AT(1)-receptor blockers , ACE inhibitors ) BACKGROUND Nonsteroidal anti-inflammatory drugs may attenuate the antihypertensive effects of diuretics , beta-blockers , angiotensin-converting enzyme inhibitors , central alpha-agonists , and other vasodilators . Their effects on the antihypertensive efficacy of calcium channel blockers are inadequately studied in small numbers of patients but appear to be minimal . METHODS A three-phase , r and omized , double-blind , placebo-controlled  multicenter study included 162 patients aged 18 to 75 years with essential hypertension . After diastolic blood pressure was controlled to 90 mm Hg or less with once-daily verapamil hydrochloride , patients received ibuprofen , naproxen , or placebo matching capsules for 3 weeks , and blood pressure , heart rate , weight , and adverse effects were evaluated . A general linear model with 95 % confidence intervals was used to compare each nonsteroidal anti-inflammatory drug treatment group with the placebo group . RESULTS No significant differences in sitting , st and ing , or supine blood pressure were noted with naproxen or ibuprofen compared with placebo . The percentages of patients in each treatment group with increases of 10 mm Hg or more in either systolic or diastolic blood pressure were similar . Statistically significant increases in weight were seen with both nonsteroidal anti-inflammatory drug therapies . Changes in pulse rate were not significant . The incidence of adverse effects was similar across all three treatment groups . CONCLUSIONS The addition of naproxen or ibuprofen to the treatment of hypertensive patients in whom blood pressure is controlled by once-daily verapamil does not cause an increase in blood pressure .  Verapamil may therefore offer considerable advantages in maintaining control of blood pressure in patients who regularly receive nonsteroidal anti-inflammatory drug therapy & NA ; In this industrial‐based study we compared the blood pressure (BP)‐lowering effectiveness of relaxation , a beta blocker , and the combined use of these two treatments in 47 untreated , mildly hypertensive blue collar steel workers . Using a r and omized two by two factorial design , patients received either nadolol or placebo drug daily , and either a relaxation training or an education program , each lasting 8 weeks . A pre‐intervention and post‐intervention stress test measured response of heart rate and BP to mental and physical tasks . BP assessment s were done at baseline , post‐intervention , 1 month , and 3 month follow‐up . Change in several self‐report measures was determined . Results showed that beta blocker was more effective in lowering BP than placebo , but relaxation was not more effective in lowering BP than health education . The combined effect of beta blocker and relaxation was not superior to beta blocker alone . Compliance with relaxation practice was not superior to compliance with medication . We conclude that pharmacologic treatment is superior to the relaxation therapy tested The comparative antianginal effects and safety of propranolol and celiprolol , a highly beta 1-selective adrenoceptor blocker with selective partial beta 2-adrenoceptor agonist activity , were assessed in an international multicenter , placebo run-in , active control , double-blind , r and omized , titration-to-effect study of 140 patients with stable , exercise-induced angina pectoris . At baseline , all patients received placebo for 2 weeks , then titrated doses of once-daily celiprolol ( 200 , 400 , 600 mg ) or twice-daily propranolol ( total daily dose 80 , 160 , 320 mg ) over 4 weeks , followed by a 2-week maintenance period . Heart rate and blood pressure , at rest and with exercise , weekly anginal attack frequency , nitroglycerin consumption and symptom-limited treadmill exercise times ( modified Bruce protocol ) were assessed . Compared with their respective baselines , both celiprolol and propranolol reduced anginal attack and nitroglycerin consumption rates to a comparable degree , while improving exercise tolerance ( p less than 0.05 ) . Treatment with propranolol compared with celiprolol , however , was associated with a significantly lower heart rate at rest ( p less than 0.01 ) . The double-product at the conclusion of exercise testing was significantly reduced by both drugs . Celiprolol and propranolol had similar effects on blood pressure , and were well tolerated . More symptomatic bradycardia occurred with propranolol . Despite the differences in their hemodynamic actions , once-daily celiprolol is as effective as twice-daily propranolol in the treatment of patients with stable angina pectoris In addition to laryngoscopy , endotracheal intubation , and other stressful intraoperative phases , hypertension occurs during recovery from anaesthesia , provoking post-operative complications like bleeding and increased intracranial or intraocular pressure . Furthermore , these hypertensive reactions result in life-threatening complications , especially in patients with pre-existing cardiovascular diseases . In this study , the effect of the new , short-acting beta-blocker esmolol given as a single bolus for preventing the increases in blood pressure and heart rate during recovery from anaesthesia and extubation in patients with hypertension was investigated . PATIENTS AND METHODS . Sixty-three patients with a history of hypertension over a period of more than 6 months and blood pressure ( BP ) more than 150/90 mm Hg undergoing intervertebral-disc , otolaryngologic , or eye surgery were included in the study . The operations were performed during thiopentone-induced isoflurane anaesthesia with relaxation by atracurium . The patients were assigned to three groups after giving witnessed oral informed consent . During the study period they received the study drug twice : ( A ) 30 - 90 s before turning off the nitrous oxide ; and ( B ) 20 - 90 s before extubation . Group I ( placebo ) received placebo each time , group II ( 100 mg esmolol ) placebo at A and 100 mg esmolol i.v . at B , and group III ( 200 mg esmolol ) 100 mg esmolol i.v . each time . After each medication the cardiovascular parameters were measured noninvasively over a period of 10 min every minute and in the following 2 h every 15 min . RESULTS . After the first medication systolic and diastolic BP , heart rate ( HR ) , and rate-pressure product ( RPP ) were lower in patients receiving 100 mg esmolol ( Group III ) than in groups I and II . After the second injection the blood pressure was lower in the two groups receiving 100 mg esmolol , than the placebo group ( I : 180.1 + /- 7.4/100.7 + /- 3.6 ; II : 152.8 + /- 5.8/87.9 + /- 3.4 ; III : 157.9 + /- 5.3/91.5 + /- 3.6 mm Hg [ mean 2 min + /- SEM ] ) . The changes in HR ( I : 88.2 + /- 3.8 ; II : 75.6 + /- 2.6 ; III : 72 + /- 3.1 min-1 ) and RPP ( I : 15,800 + /- 900 ; II : 11,700 + /- 700 ; III : 11,400 + /- 600 ) were similar . In 8 of the 20 patients in group III the HR dropped below 60.min-1 , but in none of these patients did the BP become instable . CONCLUSIONS . The sympathoadrenergic reaction during recovery from anaesthesia and extubation can be treated by beta-blocking agents , but such therapy is not without risk because of the long half-life and effects of the therapy on other factors such as postoperative loss of intravascular volume . Esmolol is a new , short-acting , cardioselective beta-blocker with a very short plasma distribution time and a elimination half-life of 9.2 min . Thus , the potential risks of beta-blockers due to half-life are minimised . The results of this study show that a dangerous increase in BP and HR with increased myocardial oxygen consumption can be prevented by a single bolus , and better by a double bolus of 100 mg esmolol . Although bradycardia with HR below 50.min-1 in 8 patients might indicate a risk of cardiac instability , the systolic BP did not fall below 100 mm Hg , and the episode of bradycardia was so short that there was no risk to the patients BACKGROUND Age and race categories or renin profiling have been recommended to predict blood pressure responses to monotherapy with a beta-blocker or thiazide diuretic . Whether these or other characteristics predict blood pressure responses when the drugs are administered as add-on therapy is uncertain . METHODS We evaluated predictors of blood pressure response in 363 men and women < or = 65 years of age with primary hypertension ( 152 blacks , 211 whites ) , 86 of whom ( 24 % ) were untreated and 277 of whom ( 76 % ) were withdrawn from previous antihypertensive drugs before r and omization to either atenolol followed by addition of hydrochlorothiazide ( N = 180 ) or hydrochlorothiazide followed by addition of atenolol ( N = 183 ) . Responses were determined by home blood pressure averages before and after each drug administration . Race , age , plasma renin activity , and other characteristics including pretreatment blood pressure levels were incorporated into linear regression models to quantify their contributions to prediction of blood pressure responses . RESULTS Plasma renin activity and pretreatment blood pressure level consistently contributed to prediction of systolic and diastolic responses to each drug administered as mono- and as add-on therapy . Higher plasma renin activity was consistently associated with greater blood pressure responses to atenolol and lesser responses to hydrochlorothiazide . The predictive effects of plasma renin activity were statistically independent of race , age , and other characteristics . CONCLUSIONS Plasma renin activity and pretreatment blood pressure level predict blood pressure responses to atenolol and hydrochlorothiazide administered as mono- and as add-on therapy in men and women < or = 65 years of age
Pindolol , celiprolol and alprenolol  lowered SBP and DBP compared to placebo .
Acebutolol  lowered SBP but there was no clear evidence that it lowered DBP .
There was no clear evidence that pindolol and  oxprenolol lowered SBP or DBP .
Higher dose partial agonists did not appear to provide additional BP lowering effects compared to lower dose .
There was no evidence of a greater effect at doses higher than the initial doses .
Based on the indirect comparison of the results in this review and two Cochrane review s on angiotensin-converting-enzyme ( ACE ) inhibitors and angiotensin receptor blockers ( ARBs ) , which also used similar inclusion criteria as this review , the BP lowering effect appeared to be less than the effect in patients with mild to moderate elevated BP who were taking ACE inhibitors  and ARBs based on an indirect comparison .
Withdrawals due to adverse effects were only reported in one trial so it is impossible to assess the harm of these drugs
BACKGROUND Partial agonists are a subclass of beta blockers used to treat hypertension in many countries .
Partial agonist act by stimulating beta receptors when they are quiescent and blocking beta receptors when they are active .
The blood pressure ( BP ) lowering effect of partial agonist beta blockers has not been quantified .
OBJECTIVES To quantify the dose-related effects of various partial agonists beta blockers on systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) and heart rate versus placebo in patients with primary hypertension .