This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Barry J. Materson, MD, MBA; Domenic J. Reda, MS; Richard A. Preston, MD; William C. Cushman, MD; Barry M. Massie, MD; Edward D. Freis, MD; Mahendr S. Kochar, MD; Robert J. Hamburger, MD; Carol Fye, RPh, MS; Raj Lakshman, PhD; John Gottdiener, MD; Eli A. Ramirez, MD; William G. Henderson, PhD; Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents; Barry J. Materson, MD, MBA; Richard A. Preston, MD; Joseph Asch, MD; Mary H. Smith, RN; Clydie Rainey; William G. Henderson, PhD; Domenic J. Reda, MS; Jean Rowe; Shirley Tir; David Williams, MS; Mazen Abdellatif, MS; Barbara Lizano, MS; Dolly Koontz; Barbara Mackay; Mike R. Sather, RPh, MS; Carol Fye, RPh, MS; Sandra Buchanan; Claude Foy; Frances Chacon; Edward D. Freis, MD; Ibrahim Khatri, MD; Barbara Gregory, RN; John Gottdiener, MD; Aldo Notargiacomo; Raj Lakshman, PhD; Rhonda Sapp; Peter Coutlakis; Eli A. Ramirez, MD; Jose L. Cianchini, MD; Alba Jimenez, RN; San Juan, PR; Robert J. Hamburger, MD; Mike Tobin; Ann Pieczek, RN; Frederick N. Talmers, MD; Chris Grant, RN; William W. Neal, MD; Martin Henry, PA; Kalman C. Mezey, MD; Barbara Luzniak, RN; Richard E. Borreson, MD; Colleen Stewart, RN; Narain T. Srivastava, MD; Karen M. Cooper, RN; Lois Anne Katz, MD; Rosemary Mannix, RN; William C. Cushman, MD; Stewart Nunn, MD; Anita McKnight, RN; Mahendr S. Kochar, MD, MBA; Dee Trottier, RN; Patricia Olzinski, RN; H. Mitchell Perry, Jr, MD; Deborah Berg, RN; Larry Monahan, PA; Judy Politte, RN; Barry Massie, MD; Julio Tubau, MD; Elaine Der, RN; Bangshi Mukherji, MD; Marion Pannone, RN; Charlene Arnold, RN; Kathleen Fox, PA; Walter M. Kirkendall, MD; William H. Gaasch, MD; Ray W. Gifford, Jr, MD; Robert F. Woolson, PhD; Daniel Deykin, MD; Ping Huang, PhD; Janet Gold

Arch Intern Med. 1995;155(16):1757-1762.

Abstract
Background
An important issue in clinical practice is how to treat patients whose blood pressure does not respond to the first antihypertensive drug selected.

Objective
To analyze the antihypertensive response of patients who had failed to achieve their diastolic blood pressure goal (<90 mm Hg at the end of 8 to 12 weeks of titration) with one of six randomly allocated drugs or placebo to the random allocation of an alternate drug.

Methods
We initially randomized 1292 men with diastolic blood pressure of 95 to 109 mm Hg to treatment with hydrochlorothiazide, atenolol, captopril, clonidine hydrochloride, diltiazem hydrochloride (sustained release), prazosin hydrochloride, or placebo. Of 410 men in whom initial treatment failed, 352 qualified for randomization to the alternate drug.

Results
Of the 352 patients, 173 (49.1%) achieved their goal diastolic blood pressure, in 133 (37.8%) the alternate drug failed, and 46 (13.1%) left the study for various reasons. Overall response rates were as follows: diltiazem, 63%; clonidine, 59%; prazosin, 47%; hydrochlorothiazide, 46%; atenolol, 41%; and captopril, 37%. The best response rate for patients in whom hydrochlorothiazide failed was achieved with diltiazem (70%); after atenolol failure, clonidine (86%); after captopril failure, prazosin (54%); after clonidine failure, diltiazem (100%); after diltiazem failure, captopril (67%); and after prazosin failure, clonidine (53%). The combined response rate for patients initially randomized to an active treatment was 76.0%, which is similar to that achieved by the combination of two drugs in previous studies.

Conclusions
We conclude that sequential single-drug therapy is a rational approach for treatment of hypertension in patients in whom initial drug therapy has failed.

(Arch Intern Med. 1995;155:1757-1762)

Author Affiliations
Miami, Fla; Hines, Ill; Albuquerque, NM; Washington, DC; Boston, Mass; Allen Park, Mich; Dallas, Tex; East Orange, NJ; Houston, Tex; Jackson, Miss; Manhattan, NY; Memphis, Tenn; Milwaukee, Wis; St Louis, Mo; San Francisco, Calif; Topeka, Kan; Data Monitoring Board; University of Texas Medical School, Houston; Worcester (Mass) Memorial Hospital; Cleveland (Ohio) Clinic Foundation; University of Iowa College of Medicine, Iowa City. Veterans Affairs Central Office; Boston and Washington

From the Cooperative Studies Program, Medical Research Service, Department of Veterans Affairs, Washington, DC. Members of the Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents are listed in a box on page 1762.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Review: Prehypertension: should we be treating with pharmacologic therapy?
Egan et al.
Ther Adv Cardiovasc Dis 2008;2:305-314.
ABSTRACT  

Hypertension and the Vascular Patient
Samson
VASC ENDOVASCULAR SURG 2004;38:103-119.
ABSTRACT  

Review: Rationale for combination therapy in the treatment of hypertension
Sica
Journal of Renin-Angiotensin-Aldosterone System 2002;3:63-65.
ABSTRACT  

Pulse Pressure Changes With Six Classes of Antihypertensive Agents in a Randomized, Controlled Trial
Cushman et al.
Hypertension 2001;38:953-957.
ABSTRACT | FULL TEXT  

Placebo-Associated Blood Pressure Response and Adverse Effects in the Treatment of Hypertension: Observations From a Department of Veterans Affairs Cooperative Study
Preston et al.
Arch Intern Med 2000;160:1449-1454.
ABSTRACT | FULL TEXT  

The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
Arch Intern Med 1997;157:2413-2446.
ABSTRACT