 |
|
A Randomized Controlled Trial of the Effects of Three Antihypertensive Agents on Blood Pressure Control and Quality of Life in Older Women
William B. Applegate, MD, MPH;
Harry L. Phillips, MD;
Harold Schnaper, MD;
Alexander M. M. Shepherd, MD, PhD;
Douglas Schocken, MD;
Judith Challop Luhr, PhD;
Gary G. Koch, PhD;
Glen D. Park, PharmD
Arch Intern Med. 1991;151(9):1817-1823.
Abstract
| |
We conducted a multicenter, randomized, double-blind, parallel group trial to compare the impact of titrated doses of atenolol (50 to 100 mg once a day), enalapril (5 to 20 mg once a day), and diltiazem (sustained release) (60 to 180 mg twice a day) on blood pressure and quality of life in older hypertensive women. Two hundred forty-two patients were randomized. Dose titration was completed by week 4 after randomization, and the maintenance phase was completed at week 16. Diltiazem (sustained release) demonstrated greater diastolic blood pressure lowering at both weeks 8 and 16 by an intent-to-treat analysis. At week 16, diltiazem changed diastolic blood pressure -13.7±0.7 mm Hg compared with -10.8±1.1 mm Hg for atenolol, and -10.5±0.9 mm Hg for enalapril. Diltiazem also demonstrated greater lowering of systolic blood pressure at week 8, but these differences in systolic blood pressure had decreased by week 16. More patients were classified as treat. ment failures during the 16 weeks of the trial for atenolol (15%) than for diltiazem (2.5%), while the treatment failure rate was intermediate with enalapril (8%). Total rates of adverse events were equivalent across the three treatment arms. There were few significant differences in the impact of the three treatments on mean scores of quality-of-life measures at week 16. There was a trend for atenolol to have somewhat worse quality-of-life scores, but none of these differences were statistically significant. In conclusion, all three treatment regimens were effective in lowering diastolic blood pressure without significant differences in rates of adverse events or deleterious effects on quality of life.
(Arch Intern Med. 1991;151:1817-1823)
Author Affiliations
From the University of Tennessee, Memphis (Dr Applegate); Columbiana (Ala) Associates (Dr Phillips); the University of Alabama at Birmingham (Dr Schnaper); the University of Texas Health Sciences Center at San Antonio (Dr Shepherd); the University of South Florida, Tampa (Dr Schocken); the University of North Carolina, Chapel Hill (Dr Koch); Marion Merrell Dow Inc, Kansas City, Mo (Dr Park); Dr Luhr is in private practice in Forest Hills, NY. A complete listing of participants in this multicenter study appears at the end of this article.
Footnotes
Accepted for publication March 21, 1991.
Reprint requests to 66 N Pauline St, Suite 232, Memphis, TN 38105 (Dr Applegate).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Neurocognitive Costs and Benefits of Psychotropic Medications in Older Adults
Brooks and Hoblyn
J Geriatr Psychiatry Neurol 2007;20:199-214.
ABSTRACT
Antihypertensive Drug Therapies and the Risk of Ischemic Stroke
Klungel et al.
Arch Intern Med 2001;161:37-43.
ABSTRACT
| FULL TEXT
{beta}-Blockers as first-line therapy for hypertension
Heckman et al.
CMAJ 2000;163:1424-1425.
FULL TEXT
Relationships of Quality-of-Life Measures to Long-term Lifestyle and Drug Treatment in the Treatment of Mild Hypertension Study
Grimm et al.
Arch Intern Med 1997;157:638-648.
ABSTRACT
Choice of Initial Therapy for Hypertension
Kaplan and Gifford
JAMA 1996;275:1577-1580.
ABSTRACT
Impact of Continued Geriatric Outpatient Management on Health Outcomes of Older Veterans
Burns et al.
Arch Intern Med 1995;155:1313-1318.
ABSTRACT
Trends in Medication Choices for Hypertension in the Elderly : The Decline of the Thiazides
Monane et al.
Hypertension 1995;25:1045-1051.
ABSTRACT
| FULL TEXT
Impact of the Treatment of Isolated Systolic Hypertension on Behavioral Variables: Results From the Systolic Hypertension in the Elderly Program
Applegate et al.
Arch Intern Med 1994;154:2154-2160.
ABSTRACT
A Critical Appraisal of the Quality of Quality-of-Life Measurements
Gill and Feinstein
JAMA 1994;272:619-626.
ABSTRACT
Selected Factors That Influence Responses to Antihypertensives: Choosing Therapy for the Uncomplicated Patient
Carter et al.
Arch Fam Med 1994;3:528-535.
ABSTRACT
Reserpine and the Medical Marketplace
Lederle et al.
Arch Intern Med 1993;153:705-706.
ABSTRACT
|
