Key result
Chlorthalidone in fixed combination with slow-release metoprolol achieved a diastolic blood pressure of <95 mmHg in 82.5% of patients compared to 45.6% with chlorthalidone alone.
Why the study?
Does chlorthalidone in fixed combination with slow-release metoprolol improve blood pressure control compared to chlorthalidone alone in out-patients with essential hypertension?
RCT (n=545)
Double-blind
Does chlorthalidone in fixed combination with slow-release metoprolol improve blood pressure control compared to chlorthalidone alone in out-patients with essential hypertension?
Absolute Event Rate: 82.5% vs 45.6%
A fixed combination of chlorthalidone and slow-release metoprolol is more effective than chlorthalidone alone in achieving diastolic blood pressure control in patients with essential hypertension.
Supports combination over chlorthalidone monotherapy for hypertension control; extends RCT evidence for beta-blocker-diuretic fixed dosing.
In a double-blind trial, 545 out-patients with essential hypertension received 25 mg/day chlorthalidone alone (274 patients) or in fixed combination with 200 mg/day slow-release metoprolol (271 patients) for 8 weeks. Both treatments significantly (P less than 0.001) decreased systolic and diastolic blood pressure; 45.6% of patients receiving chlorthalidone and 82.5% receiving combined therapy had a diastolic blood pressure of less than 95 mmHg. Patients not controlled by chlorthalidone or chlorthalidone plus metoprolol subsequently received chlorthalidone plus metoprolol (137 patients) or chlorthalidone plus metoprolol plus a third drug (34 patients), respectively, for 8 weeks. A total of 79.5% of patients receiving chlorthalidone plus metoprolol and 61.8% receiving chlorthalidone plus metoprolol plus a third drug had a diastolic blood pressure of less than 95 mmHg. Only 5.9% of patients experienced mild to moderate side-effects. Plasma potassium levels significantly (P less than 0.01) decreased during the first 8 weeks only. It is concluded that a diuretic alone or in fixed combination with a beta-blocker is effective in the long-term treatment of arterial hypertension.
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Bichisao et al. (1989) conducted an RCT in essential hypertension (n=545). Chlorthalidone in fixed combination with slow-release metoprolol vs. Chlorthalidone alone (25 mg/day) was evaluated on Diastolic blood pressure of less than 95 mmHg. Chlorthalidone in fixed combination with slow-release metoprolol achieved a diastolic blood pressure of <95 mmHg in 82.5% of patients compared to 45.6% with chlorthalidone alone.
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