Griebenow R, Pittrow DB, Weidinger G, Mutschler E
Antihypertensive efficacy and tolerability of a low-dose
reserpine/thiazide combination compared to an ace-
inhibitor in first-line treatment
11th Scientific Meeting, American Society of Hypertension
Am J Hypert
(Apr) 9:119A 1996
A combination of reserpine (0.1 mg) and a thiazide diuretic (clopamid,
5 mg) was compared to enalapril (5 mg) in 127 hypertensives with
diastolic blood pressure between 100 and 114 mmHg (average 156/104
mmHg). If diastolic BP remained above 90 mmHg after 3 weeks of
treatment, the dose of medication was doubled and treatment continued
for 3 additional weeks. The combination therapy lowered blood pressure
more than the ACE inhibitor at both 3 weeks (-19.6/-17.0 v. -6.1/-9.5
mmHg, delta SBP/delta DBP, p <0.001) and 6 weeks (-23.5/-19.1 v. -10.2/-11.6
mmHg, p<0.001). There was no significant difference in the incidence
of adverse events between the 2 treatments. The authors conclude that
reserpine/diuretic is an effective, well- tolerated alternative to
ACEI as initial treatment.
Comment: It would appear that antihypertensive drug
treatment has come full circle. The early VA Trial experience
employed the reserpine-diuretic approach and demonstrated both
efficacy and safety. Unfortunately, a reported association of breast
cancer with reserpine treatment, later proven false, seriously
undermined confidence in reserpine's safety, and the subsequent
introduction of novel agents, e.g., methyldopa, all but killed
reserpine as an antihypertensive. The drug remains widely available
in generic form, is amongst the least expensive antihypertensive
medications and, as shown again in this study, is very effective when
combined with a diuretic. The design of the study may overstate the
difference in efficacy between the combination and the ACE inhibitor,
as BP was measured 24 hours after dosing, and enalapril is known to
have a poor peak/trough ratio at the dose used.
(Alan Weder, M.D., University of Michigan)
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11th Scientific Meeting, American Society of Hypertension
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