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European Heart Journal 1986 7(10):885-892;
Copyright © 1986 by the European Society of Cardiology.
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© 1986 The European Society of Cardiology

Beta-blocker versus diuretic for control of the blood pressure response to stress in hypertensive patients

S. C. WU, M. B. SECCHI, S. MANCARELLA, L. BETTAZZI, M. CIVELLI, A. CIRÒ, L. OLTRONA and G. FOLLI*

Divisione di Medicina, Ospedale Bassini Cinisello Balsamo, Milan
*Istituto di Patologia Medica, Università Cattolica del Sacro Cuore, Policlinico Gemelli Rome, Italy

revised 14 March 1986; accepted 10 December 1985.

Address for reprinis: Dr Sheng Chin Wu, Via P, Moscati 6,20154 Milan, Italy

Abstract

To compare the antihypertensive effects of beta-blockers and diuretics on the blood pressure increase to stress, a randomized single-blind crossover study was performed in 27 patients with mild or moderate hypertension. At the initial examination and after two subsequent periods of therapy with 100 mg atenolol or with a combination of 50 mg hydrochlorothiazide and 5 mg amiloride hydrochloride, once a day, blood pressure and heart rate were measured at rest, during mental arithmetic, sustained handgrip and cycloergometric test. Both treatment significantly decreased supine and standing systolic and diastolic pressure at rest, during and immediately after mental stress and isometric exercise, with the reduction of diastolic pressure significantly greater after atenolol. During dynamic exercise, systolic and diastolic pressures were significantly decreased by diuretics at the lowest work-load only, whereas beta-blocker caused significant and greater blood pressure reductions throughout the exercise. The combination of two classes of drug normalized resting blood pressure in 8 of 9 sub ects in which the monotherapy had failed to obtain values less than 140/90 mmHg and gave a better control of systolic and diastolic pressures throughout all the stress tests.

It is concluded that atenolol is more effective than diuretics during stress, suggesting that beta-blocking drugs are the first choice treatment for mild to moderate hypertension and that when the antihypertensive effect of a single agent is insufficient, a combination of beta-blocker s and diuretics is also effective during stress.

Key Words: antihypertensive treatment • beta-blocker • diuretic • exercise blood pressure • handgrip • mental stress


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