Fagard R, Amery A, De Plaen J F, Lijnen P, Missotten A
Acta Cardiol. 1976;31(5):411-26.
Fifty-five patients with mild to moderate, renal or essential hypertension were admitted to a double blind cross-over trial of 18 weeks, involving treatment periods with placebo, the thiazide bendrofluazide (15 mg daily) and the beta blocker atenolol (600 mg daily). Compared to the placebo period (190/117 mm Hg) the hypotensive effect of atenolol (-24/16 mm Hg) was more pronounced than the hypotensive effect of bendrofluazide (-17/6 mm Hg). Arguments in favor of initiating antihypertensive drug therapy with beta blocker were its more powerful hypotensive effect, the quicker onset of its action, less metabolic disturbance, decreased frequency of complaints and patient's preference. On thiazides body weight and the frequency of swollen ankles decreased. Plasma renin concentration was not found to have a strong predicting power for the hypotensive effect of atenolol or bendrofluazide but low renin patients showed a more pronounced blood pressure decrease on bendrofluazide and high renin patients, especially essential hypertensives, on atenolol. While these points can be a guide to therapy today, the preference of one drug over the other must eventually be based on their relative efficacy in decreasing morbidity and mortality from the hypertensive disease.
55例轻度至中度肾性或原发性高血压患者被纳入一项为期18周的双盲交叉试验，试验包括安慰剂治疗期、噻嗪类药物苄氟噻嗪（每日15毫克）治疗期和β受体阻滞剂阿替洛尔（每日600毫克）治疗期。与安慰剂治疗期（190/117毫米汞柱）相比，阿替洛尔的降压效果（-24/16毫米汞柱）比苄氟噻嗪的降压效果（-17/6毫米汞柱）更显著。支持以β受体阻滞剂开始抗高血压药物治疗的理由是其降压效果更强、起效更快、代谢紊乱更少、主诉频率降低以及患者的偏好。使用噻嗪类药物后体重和脚踝肿胀频率降低。未发现血浆肾素浓度对阿替洛尔或苄氟噻嗪的降压效果有很强的预测能力，但低肾素患者使用苄氟噻嗪时血压下降更显著，高肾素患者，尤其是原发性高血压患者，使用阿替洛尔时血压下降更显著。虽然这些观点目前可作为治疗的指导，但最终选择一种药物而非另一种药物必须基于它们在降低高血压疾病发病率和死亡率方面的相对疗效。
