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Hydrochlorothiazide and Atenolol Combination Antihypertensive Therapy: Effects of Drug Initiation Order
Author(s) -
Johnson JA,
Gong Y,
Bailey KR,
CooperDeHoff RM,
Chapman AB,
Turner ST,
Schwartz GL,
Campbell K,
Schmidt S,
Beitelshees AL,
Boerwinkle E,
Gums JG
Publication year - 2009
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1038/clpt.2009.101
Subject(s) - atenolol , hydrochlorothiazide , combination therapy , thiazide , medicine , blood pressure , pharmacology , urology , dosing , diuretic , antihypertensive drug
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