Hypertension in the elderly: a study of a combination of atenolol, hydrochlorothiazide and amiloride hydrochloride.

The anti-hypertensive effects of atenolol (Tenormin) 50 mg, a potassium-sparing diuretic (half-strength Moduretic) comprising hydrochlorothiazide 25 mg plus 2.5 mg amiloride hydrochloride, and the 'free' combination of atenolol and diuretic were compared in elderly hypertensive patients aged 60-79 years. After a four-week run-in period on placebo, patients were randomly assigned, in a double-blind manner, to atenolol or diuretic treatment, each for four weeks. Thereafter patients were given the 'free' combination for a further four weeks and this treatment was continued for six months. Blood pressure and heart rate were measured after the patient had rested for five minutes supine and after two minutes standing. These blood pressure measurements were made at least 24 hours after the preceding dose using a Random Zero sphygmomanometer. Results from 26 of the 27 patients entered into the study showed an advantage for combination therapy combined with either atenolol or diuretic treatment alone. No significant difference was found between treatments in the frequency of supraventricular and ventricular ectopic beats occurring in six patients who underwent 24-hour ambulatory ECG monitoring. However, ectopic activity was reduced in some patients during beta-blocker treatment. Few adverse effects occurred with any treatment. Three patients withdrew during the placebo period and three withdrew while taking active treatment. This study has shown that the combination of atenolol, hydrochlorothiazide and amiloride hydrochloride is an effective, safe, well-tolerated antihypertensive drug regimen when used once daily in elderly hypertensive patients.

Hypertension in the elderly: a study of a combination of atenolol and nifedipine.

The antihypertensive effects and tolerability of a once-daily, fixed combination of atenolol 50 mg and nifedipine retard 20 mg ('Nif-Ten') were monitored in a 12-month open study in 30 elderly hypertensive patients, whose blood pressure was inadequately controlled after four weeks treatment with atenolol 50 mg once daily. Sitting (and standing) blood pressure and heart rate one to four hours after dosing were recorded at entry (191/95 mmHg) and at the end of the run-in period (186/93 mmHg). After one month's therapy with the fixed combination the mean sitting blood pressure fell to 169/89 mm Hg and was maintained at this level for the entire 12-month period of observation. During the study four patients complained of side effects on fixed combination therapy with one patient withdrawn due to flushes and hot sweats. One other patient suffered flushes and hot sweats and two patients complained of mild dizziness. There were no demonstrable effects of fixed combination therapy upon the biochemical parameters measured. We conclude that the fixed combination of atenolol plus nifedipine retard was well tolerated over a 12-month period in the group of elderly hypertensive patients studied. The combination appears to exert a greater antihypertensive effect than the beta-blocker monotherapy with no evidence of tachyphylaxis, although these findings require confirmation in a controlled trial.

Prognostic indicators of septicaemia--a two year prospective evaluation.

The problem of septicaemia in a district general hospital was studied prospectively over a two year period, with respect to factors affecting prognosis. Age had little influence on the outcome, although several factors showed age-related trends which tended to be unfavourable to survival. The mortality among patients over 65 years of age was 39.5% and this was not significantly different from the mortality of 34.5% among those below that age. It is suggested that by taking into consideration simple clinical and laboratory findings like sex, source of infection, intercurrent illness, blood urea, pulse rate and temperature, it is possible to predict prognosis with reasonable accuracy without recourse to excessive expenditure of money or resources.