Hydrochlorothiazide and Atenolol Combination Antihypertensive Therapy: Effects of Drug Initiation Order

For combination antihypertensive therapy with thiazide diuretics and β‐blockers, the effect of the order of initiation of the drugs on the outcome has not been tested. Patients with uncomplicated hypertension were randomized to receive either hydrochlorothiazide (HCTZ) or atenolol monotherapy, follo...

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Bibliographic Details
Published in:Clinical pharmacology and therapeutics 2009-11, Vol.86 (5), p.533-539
Main Authors: Johnson, JA, Gong, Y, Bailey, KR, Cooper‐DeHoff, RM, Chapman, AB, Turner, ST, Schwartz, GL, Campbell, K, Schmidt, S, Beitelshees, AL, Boerwinkle, E, Gums, JG
Format: Article
Language:English
Subjects:
Adult
African Continental Ancestry Group
Antihypertensive Agents - administration & dosage
Antihypertensive Agents - therapeutic use
Atenolol - administration & dosage
Atenolol - therapeutic use
Blood Pressure - drug effects
Drug Administration Schedule
Drug Therapy, Combination
European Continental Ancestry Group
Female
Follow-Up Studies
Humans
Hydrochlorothiazide - administration & dosage
Hydrochlorothiazide - therapeutic use
Hypertension - drug therapy
Hypertension - physiopathology
Male
Middle Aged
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Summary:For combination antihypertensive therapy with thiazide diuretics and β‐blockers, the effect of the order of initiation of the drugs on the outcome has not been tested. Patients with uncomplicated hypertension were randomized to receive either hydrochlorothiazide (HCTZ) or atenolol monotherapy, followed by addition of the alternative drug. Blood pressure (BP) responses were evaluated by race and order of drug initiation. A total of 368 participants received combination therapy. Among the participants, blacks showed a greater BP‐lowering effect than whites did with HCTZ monotherapy (−13.0/−7.4 mm Hg vs. −8.0/−4.2 mm Hg, P < 0.001) but a smaller BP‐lowering effect than did whites with atenolol monotherapy (−1.1/−2.9 mm Hg vs. −9.9/−9.2 mm Hg, P < 0.0001). These differences were not evident during combination therapy. However, both groups showed greater response to HCTZ + atenolol than to atenolol + HCTZ (−19.1/−14.2 mm Hg vs. −15.6/−11.3 mm Hg, P < 0.0001). Despite optimal dosing of HCTZ + atenolol, only two‐thirds of the participants achieved BP control. In HCTZ/atenolol combination antihypertensive therapy, the order in which the drugs are initiated affects total BP lowering during the first 4–6 months of therapy. Clinical Pharmacology & Therapeutics (2009) 86 5, 533–539. doi:10.1038/clpt.2009.101
ISSN:0009-9236
1532-6535
DOI:10.1038/clpt.2009.101