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 .
Comparison of once daily atenolol, nitrendipine and their combination in mild to moderate essential hypertension.
1 . The aim of the study was to compare the efficacy and the tolerability of treatment with atenolol ( 50 - 100 mg once daily ) , nitrendipine ( 20 - 40 mg once daily ) and their combination ( atenolol 50 mg + nitrendipine 20 mg ) once daily in patients with mild to moderate essential hypertension . 2 . The study was a r and omised , double-blind , placebo controlled parallel groups design : blood pressures were measured at ' trough ' effect ( i.e. 24 h after dosing ) to assess the adequacy of once-daily treatment . 3 . Mean blood pressures ( mm Hg ) recorded on four occasions over 12 weeks of treatment were significantly lower both with atenolol ( 155/97 sitting : 155/104 st and ing ) and with the combination of atenolol plus nitrendipine ( 153/96 sitting : 152/104 st and ing ) than with placebo ( 169/108 sitting : 169/114 st and ing ) . Nitrendipine alone had no significant effect on blood pressure 24 h after dosing ( 165/104 sitting : 165/110 st and ing ) . 4 . Withdrawals due to adverse effects were more common during treatment with nitrendipine : 7/32 of the patients experienced adverse effects attributable to intense systemic vasodilatation ( e.g. , flushing , erythema , headache ) . 2/37 patients taking atenolol  were withdrawn : one because he developed a psoriatic rash and the other because of impaired peripheral circulation . Of the 35 patients taking combination treatment , two were withdrawn : one developed headaches and dyspnoea , and the other asthma . 5 . The results suggest that once daily dosing with nitrendipine does not control blood pressure throughout the 24 h period in the majority of patients , and is associated with a considerable burden of adverse effects . Combination treatment was better tolerated but appeared to offer no advantages over atenolol alone in terms either of blood pressure control or adverse effects
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 .