A double-blind comparison of bisoprolol and captopril for treatment of essential hypertension in the elderly.

The aim of the study was to compare the antihypertensive efficacy and safety of a new beta blocker with high beta 1 selectivity, bisoprolol, with captopril in 28 elderly patients, aged over 65 years, with mild-to-moderate essential hypertension (WHO classes I and II). After a placebo run-in period of 4 weeks, the patients were randomly allocated to receive bisoprolol (5 mg od) or captopril (25 mg bid) (double-dummy technique) for 6 weeks, according to a crossover double-blind design, with a 4-week washout period between the two active treatments. The doses were doubled after 2 weeks if the supine blood pressure was greater than 160/95 mmHg. In basal conditions and after 2, 4, and 6 weeks of each treatment, the blood pressure and heart rate were assessed both in the supine and erect positions. At the same time, the side effects and quality of life were investigated by a checklist and a self-assessment questionnaire. Standard laboratory tests and a resting ECG tracing were performed before and after each active treatment. The data from 24 patients (4 dropouts) showed a significant antihypertensive effect of both treatments (p less than 0.01) with a reduction of diastolic blood pressure to values less than or equal to 95 mmHg in 75% (18/24) of the patients treated with bisoprolol and in 83.3% (20/24) of those treated with captopril, without significant differences between the two drugs. Bisoprolol also produces a marked but symptom-free reduction of heart rate compared with captopril (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Precapillary pulmonary hypertension: effect of Captopril]. / Ipertensione arteriosa polmonare "precapillare": effetto del captopril.

The immediate and sustained haemodynamic effects of Captopril (CPT), an oral inhibitor of angiotensin converting enzyme, were studied in six patients (pts) with severe pulmonary hypertension (PH) (pulmonary artery pressure: mean +/- SD value = 57 +/- 20 mmHg). Two pts had primary PH, 2 embolic PH and 2 Eisenmenger Physiology (EP). Administration of 100 mg of CPT in a single oral dose produced a significant decrease only in systemic arterial pressure (SAP) (p less than 0.025) and systemic vascular resistance (SVR) (p less than 0.05) in 5 of 6 pts. Heart rate (HR), cardiac index (CI), pulmonary vascular resistance (PVR), pulmonary arterial (PAP), pulmonary wedge (PWP) and right atrial pressure (RAP) did not change significantly. These results were confirmed in a repeat haemodynamic study after 4 months of long-term treatment with 50 or 100 mg of CPT 3 times daily. In 1 pt with EP and severe congestive heart failure (CHF) the same chronic treatment produced a marked decrease in HR (from 114 to 88 b/min), RAP (from 10 to 1 mmHg), PWP (from 15 to 6 mmHg), PVR (from 41 to 30 UR), SVR (from 58 to 43 UR). Systemic CI increased from 1.68 to 2.60 l/min/m2 and pulmonary CI from 1.64 to 2.5 l/min/m2; no changes were seen in PAP and SAP. These data suggest that CPT is not effective on pulmonary haemodynamics in pts with precapillary PH and normal CI whereas the drug seems to influence favourably the pulmonary circulation in pts with PH secondary to or associated with left ventricular failure. The necessity of evaluating not only PVR but PAP as well, in studying the effect of vasodilators especially in pts with precapillary PH and normal CI, is discussed. In fact a reduction of PAR without decrease of PAP, as frequently seen in previous reports, is probably due to a primary increase of CI induced by the drug.