When the blood pressure lowering effect of beta-blockers from this review was compared to that of thiazide diuretics from our previous review ( Chen 2009 ) , second-line beta-blockers reduce systolic BP to the same extent as second-line thiazide diuretics , but reduce diastolic BP to a greater degree .
The different effect on diastolic BP means that beta-blockers have little or no effect on pulse pressure whereas thiazides cause a significant dose-related decrease in pulse pressure .
This difference in the pattern of BP lowering with beta-blockers as compared to thiazides might be the explanation for the fact that beta-blockers appear to be less effective at reducing adverse cardiovascular outcomes than thiazide diuretics , particularly in older individuals
BACKGROUND Beta-blockers are one of the more commonly prescribed classes of anti-hypertensive drugs , both as first-line and second-line .
OBJECTIVES To quantify the effect on systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) , heart rate and withdrawals due to adverse effects of beta-blocker therapy when given as a second-line drug in adult patients with primary hypertension .
Atenolol and Sustained Release Nifedipine Alone and in Combination in Hypertension A Randomised, Double-Blind, Crossover Study
Summary In this r and omised , double-blind , crossover trial , the efficacy in hypertension of atenolol and nifedipine as single agents or in combination was compared . 81 patients with mild to moderate essential hypertension ( sitting diastolic blood pressure 100–120 mm Hg , aged 20–70 years ) from 6 outpatient clinics entered the study . By use of a Latin-square design , patients received , in r and omised fashion , sustained release nifedipine 20 mg twice daily , atenolol 50 mg in the morning and then placebo in the evening , or sustained release nifedipine 20 mg plus atenolol 50 mg in the morning and then placebo in the evening . Each schedule was followed for 4 weeks . All treatments lowered systolic and diastolic blood pressure in the supine and st and ing positions compared with pretreatment values . The combination regimen significantly reduced supine and st and ing systolic ( p < 0.01 and p < 0.001 , respectively ) and diastolic ( p < 0.001 ) blood pressure compared with nifedipine alone , and it also significantly reduced supine and st and ing systolic ( p < 0.01 and p < 0.03 , respectively ) and diastolic ( p < 0.01 ) blood pressure compared with atenolol  alone . Heart rate was significantly decreased by atenolol and the combination compared with nifedipine alone.15 patients withdrew because of side effects : 9 during nifedipine treatment , 2 during atenolol treatment and 4 during combination treatment . Side effects were typical of those associated with nifedipine or atenolol . Flushes and hot sweats , which were frequent with nifedipine , were significantly less ( p < 0.001 ) with atenolol or the combination . For selected patients who do not respond to monotherapy with nifedipine or atenolol , the combination regimen seems an appropriate and useful alternative to β-blocker/diuretic combinations , especially where ischaemic heart disease may co-exist
When the blood pressure lowering effect of beta-blockers from this review was compared to that of thiazide diuretics from our previous review ( Chen 2009 ) , second-line beta-blockers reduce systolic BP to the same extent as second-line thiazide diuretics , but reduce diastolic BP to a greater degree .
The different effect on diastolic BP means that beta-blockers have little or no effect on pulse pressure whereas thiazides cause a significant dose-related decrease in pulse pressure .
This difference in the pattern of BP lowering with beta-blockers as compared to thiazides might be the explanation for the fact that beta-blockers appear to be less effective at reducing adverse cardiovascular outcomes than thiazide diuretics , particularly in older individuals
BACKGROUND Beta-blockers are one of the more commonly prescribed classes of anti-hypertensive drugs , both as first-line and second-line .
OBJECTIVES To quantify the effect on systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) , heart rate and withdrawals due to adverse effects of beta-blocker therapy when given as a second-line drug in adult patients with primary hypertension .