An assessment of diltiazem and hydrochlorothiazide in hypertension: application of factorial trial design to a multicenter clinical trial of combination therapy

Article Abstract:

A randomized factorial trial design using combination therapy was conducted on a population of subjects for treatment of hypertension, high blood pressure. Several doses of diltiazem, a calcium channel blocker, and hydrochlorothiazide, a diuretic, were administered either together or alone, or else a placebo was given to 297 individuals with mild to moderate high blood pressure. There has been some controversy over whether these two drugs can exert additive antihypertensive effects when given in combination. A more complete evaluation was obtained where observation of the effect of various doses allowed for an unbiased selection of the most effective treatment. A slow-release formulation of diltiazem hydrochloride was given by itself or with hydrochlorothiazide in a series of four- to six-week trials. In general, all subjects experienced a reduction in absolute blood pressure. The combination therapy proved to be the most effective at reducing blood pressure to the desired levels. A dose-related decrease in blood pressure to goal levels was noted by 75 percent of the patients taking combination therapy, which was also well tolerated. Close to 90 percent of the subjects completed this phase of the trial, with only 10 individuals dropping out as a result of side effects. These side effects were largely attributed to hydrochlorothiazide, as they occurred when it was given alone or with diltiazem. Fifty percent of the patients experienced a reduction of blood pressure with hydrochlorothiazide alone; 57 percent achieved blood pressure reduction goals with diltiazem alone. It was concluded that slow-release diltiazem when administered with hydrochlorothiazide has an additional effect in reducing mild to moderately elevated high blood pressure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Dosage and administration, Drug interactions, Hydrochlorothiazide, Diltiazem

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Treatment of isolated systolic hypertension with labetalol in the elderly

Article Abstract:

Isolated systolic hypertension (ISH) was once thought to be a natural consequence of aging. The condition is a type of high blood pressure that involves a systolic blood pressure above 160 millimeters of mercury (mm Hg) and a diastolic blood pressure below 95 mm Hg, and is regarded as a consequence of several factors, including reduction of arterial wall compliance. ISH has been shown to be associated with increased incidence of coronary heart disease, heart failure, and stroke, yet it is uncertain whether treating ISH in the elderly results in a reduction in illness or death. Few controlled trials have specifically examined at ISH in the elderly. A report is presented of 133 patients over 60 with ISH who were enrolled in a placebo-controlled study to test the effectiveness of labetalol, a combined alpha- and beta-blocker. After 10 weeks of treatment, the treated group, consisting of 70 patients, had reductions of approximately 26 mm Hg in their systolic blood pressure, to an average of 144 mm Hg. The average reduction in the placebo group was 9 mm Hg. There were patient reports of side effects in both the treated and the placebo group, but none were serious. The patients did not experience complications such as dizziness upon changing postures. The results indicate that a twice-daily regimen of labetalol is safe and effective in elderly patients with ISH. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Labetalol

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A 42-year-old man with hypertension

Article Abstract:

Hypertension in African-Americans may be difficult to treat because many cannot afford the medications and may have other predisposing factors. In blacks and whites, hypertension has a genetic and environmental component. Blacks may be particularly susceptible because of the stress they experience and the foods they eat. Many cannot afford foods rich in potassium and calcium. The most effective treatments for hypertension are weight reduction, diet, physical activity and moderating alcohol intake. If these are not effective, diuretics and beta blockers are the drug treatment of choice.

African Americans

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