Study of the Effect of Amlodipine, Atenolol, Enalapril and Losartan in Patients with Mild to Moderate Hypertension

Objectives: To evaluate and compare the efficacy and tolerability of amlodipine, atenolol, enalapril and losartan in patients with mild to moderate hypertension. Research design and method: This study was conducted in medicine department of tertiary care teaching hospital. This was prospective, open labelled, observational, randomized controlled clinical trial. Patients aged 30-60 years, newly diagnosed as mild to moderate hypertension were enrolled in the study. Pretreatmentevaluation of all the patients was done. Detailed clinical history, physical examination and routine laboratory investigations were done. Eligible patients were randomized to receive Amlodipine 2.5/5 mg, Atenolol 25/ 50 mg, Enalapril5/ 10 mg, Losartan 25/50 mg and followed them for 12 weeks, patient’svisits scheduled at 2 weeks interval. Primary efficacy end point was reduction in mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP). Safety was assessed in terms of systemic adverse events both subjective and objective (clinical and biochemical examinations). Results: Total 154 patients were enrolled, patients’ demographic and baseline clinical characteristics were comparable in all treatment groups. After 12 weeks of treatment the reduction in mean systolic blood pressure were 22.55±7.74, 21±7.94, 20.35±5.48, 22.61±8.41. Reduction in mean diastolic blood pressure were 13.11±4.31, 10.11±3.24, 11.5±3.39, 12.72±3.38. The change in heart rate was 84.22 ± 5.71 to 85.56 ± 5.81, 83.27 ± 5.72 to 69.05 ± 7.68, 84 ± 6.17 to 85.72±5.47, 82.33 ± 7.15 to 83.5±7.54. The change in average serum potassium levels 3.81 ± 0.39 to 3.79 ± 0.36, 3.79 ± 0.33 to 3.69 ± 0.22, 3.72 ± 0.35 to 4.08 ± 0.38, 3.74 ± 0.40 to 3.81 ± 0.27. Adverse events percentage was 38.88 percent, 36.11 percent, 36.11 percent and 13.88 percent in all 4 study group respectively. Conclusion: Amlodipine, Atenolol, Enalapril, and Losartan are equal efficacious to reduce SBP and DBP, whereas losartan is better tolerated and comparatively safer than amlodipine, atenolol and enalapril in patients with mild to moderate hypertension.