Treating the older hypertensive: beta-blocker or diuretic?

Twenty-six ambulant elderly patients (age range 62 to 78 years) whose blood pressure control was inadequate with either beta-blocker or diuretic monotherapy were studied in a randomized, prospective double-blind comparison of atenolol (50 mg), amiloride (5 mg) with hydrochlorothiazide (50 mg), and these two treatments combined. Blood pressures were measured at least 24 hours after a single daily dose. The combined therapy was more effective in reducing lying (p less than 0.01) and standing (p less than 0.05) systolic blood pressure than either beta-blocker or diuretic alone. Combined therapy was more effective than diuretic on lying (p less than 0.05) or standing blood pressure (p less than 0.01). There was little difference in blood pressure control between beta-blocker and diuretic therapy. Side-effect complaints were similar on beta-blocker (5 complaints) and diuretic (7) and appeared to be additive on combined treatment (12). Diuretic treatment alone or in combination after the 1-month randomized periods produced shifts in some biochemical parameters (creatinine, urea, urate, sodium) in this older population of treated hypertensives, but clinically significant alteration in serum potassium levels was not seen.