Frishman WH
Results of treatment of hypertension with beta-blocker:diuretic
combinations -- focus on a very low-dose approach
11th Scientific Meeting, American Society of Hypertension
Am J Hypert
(Apr) 9:204A 1996
This report covers the author's experiences in two trials in which
combinations of the diuretic hydrochlorothiazide (HCTZ) and the
b-blocker bisoprolol (BIS) were evaluated for antihypertensive
efficacy and for side effects. In the first trial, a factorial design
was used to compare placebo, HCTZ (6.25 and 25 mg) and BIS (2.5, 10
and 40 mg) in combination. The main finding was that HCTZ 6.25 with
BIS 2.5 was as effective as the high-dose regimens. In a second study,
a placebo-controlled, parallel comparison of BIS 5 mg , HCTZ 25 mg and
BIS 5 mg/HCTZ 6.25 mg, the combination proved to be more effective
than placebo or BIS alone and as effective as 25 mg HCTZ. The side
effect profile of the combination was favorable.
Comment: Combination therapies seem to be undergoing a
renaissance. "Tailoring" antihypertensive therapies to specific
demographic (e.g., age, race), biochemical (e.g., renin profile) or
most recently, genetic marker, characteristics has not proven to be a
clinically useful strategy. Presently, given the side range of
effective drugs, the most important patient-specific considerations in
antihypertensive therapy are concomitant disease, side effects and
cost. As Frischman points out, low-dose combination therapies are
generally as effective as high-dose monotherapies, are well tolerated
by patients and tend to be competitively priced. It seems likely that
use of such combinations will increase in the future. (Alan Weder,
M.D., University of Michigan)
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11th Scientific Meeting, American Society of Hypertension
H: Drug therapy :
Diuretics
H: Drug therapy :
Beta blockers