Methyldopa supplement for resistant essential hypertension: a prospective randomized placebo control crossover study.

BACKGROUND: Resistant hypertension is an important public health problem, its prevalence varies between 30 to 50 per cent. However, there is no definite recommendation for the treatment of resistant hypertension (HT). MATERIAL AND METHOD: A prospective randomized placebo control crossover study in resistant HT was designed to compare safety and efficacy between methyldopa 250 mg twice daily and placebo using ambulatory blood pressure monitoring. RESULTS: 87 from 1,112 cases (7.82%) from the hypertension clinic of Vajira Hospital were found to have clinical resistant HT and 40 cases were accepted to enrolled in the study. 23 cases of true resistant HT proceeded to the treatment phase of the study and all of them completed the study. Methyldopa reduced systolic blood pressure (BP) from 153.67 to 135.23 mmHg, or -18.44 mmHg (95% confidence interval 15.13-21.75). Diastolic BP was reduced from 86.42 to 74.90 mmHg, or -11.52 mmHg (95% confidence interval 9.41-13.63). CONCLUSION: The addition of methyldopa to the optimal medical therapy contributed to the improvement of BP control among patients with resistant HT.

Blood pressure response to antihypertensive agents related to baseline blood pressure.

Prevalence of white-coat hypertension varies approximately 20 per cent among mild hypertensives. When white-coat hypertensives are prescribed antihypertensive medication, there is usually a decrease in clinic blood pressure (BP), but little or no change in 24 hours blood pressure (ABPM). The objective of the study was to test the hypothesis that efficacy of medication therapy for hypertension is identical in any grading of severity of baseline blood pressure. The authors retrospectively analysed ABPM data from mild to moderate hypertensive patients. Efficacy in decreasing blood pressure by antihypertensives has linear relation to baseline blood pressure. Response to antihypertensive agents in white-coat hypertension is minimal but a significant effect still persists and the possibility of hypotensive adverse events from medication in the case cannot be overlooked.