Why the study?
Does the addition of reserpine, methyldopa, or propranolol to hydroflumethiazide improve blood pressure control in patients with hypertension inadequately controlled by thiazide alone?
Does the addition of reserpine, methyldopa, or propranolol to hydroflumethiazide improve blood pressure control in patients with hypertension inadequately controlled by thiazide alone?
Reserpine, methyldopa, and propranolol are all effective as step 2 add-on therapies to hydroflumethiazide for hypertension, but the reserpine combination may offer advantages in cost, convenience, and tolerability.
Reserpine may be preferred as step-2 add-on to hydroflumethiazide; confirms efficacy of all three agents with highest control rate for reserpine.
A single-blind clinical trial compared step 2 combination therapy consisting of 50 or 100 mg of hydroflumethiazide plus either 0.125 to 0.250 mg of reserpine, 500 to 2,000 mg of methyldopa, or 80 to 320 mg of propranolol hydrochloride, in 59 patients whose elevated blood pressure (BP) failed to respond adequately to the thiazide alone. After nine weeks of treatment, diastolic BP was reduced below 90 mm Hg in all 20 patients treated with the reserpine-hydroflumethiazide combination, in 13 of the 19 patients treated with methyldopa and hydroflumethiazide, and in 16 of the 20 patients treated with propranolol and hydroflumethiazide. Changes in laboratory values were not substantial; adverse reactions occurred only in the methyldopa group. Although the three treatment regimens were similar with respect to safety and efficacy, the reserpine-hydroflumethiazide combination offers the advantages of more convenient dosage at lower cost.
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Frank A. Finnerty (1979) studied this question.
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