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 .
Nicardipine and propranolol in the treatment of essential hypertension.
Two hundred thirty-four patients with supine diastolic blood pressure of between 95 and 114 mm Hg were enrolled into a double-blind , r and omized , parallel , multicenter trial . The patients were r and omized to either nicardipine 30 mg tid , propranolol 40 mg tid , or nicardipine 30 mg tid and propranolol 40 mg tid for six weeks . Two hundred six patients yielded data for analyses . Of the 28 not included , seven had missing data , whereas the remaining 21 were excluded because they either failed to meet inclusion criteria or were noncompliant at endpoint . Both nicardipine and propranolol as monotherapies and in combination achieved statistically significant , ( P less than .01 ) , supine diastolic blood pressure reduction relative to baseline . The combination of nicardipine and propranolol showed a greater reduction in supine diastolic and systolic measurements than either of the monotherapies . Nicardipine produced greater blood pressure reductions one hour after dosing , whereas the propranolol treatment tended to produce slightly greater blood pressure decreases eight hours after dose . The combination always result ed in the greatest blood pressure reduction , independent of time after dose . Adverse experiences were reported by 26 % of patients in the nicardipine-treated group , most often transient vasodilatory effects , by 17 % of the propranolol-treated patients , and by 18 % of the combination-treated group . This study demonstrated at the doses studied that nicardipine alone produced equivalent blood pressure reductions to those obtained by propranolol alone , but that the combination of these two drugs produced greater reductions in blood pressures than either of the monotherapies
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 .