Groom P, Simpson R J, Singh B, Ward D E, Peers E, Richardson P D
Forth Valley GP Research Group, Department of Psychology, University of Stirling, Scotland.
Eur J Clin Pharmacol. 1988;34(1):21-4. doi: 10.1007/BF01061411.
Seventy-six uncomplicated hypertensive patients treated in General Practice, whose seated diastolic blood pressure (Phase V) (dBP) remained greater than or equal to 95 mmHg after a minimum of 4 weeks treatment with metoprolol 50 mg b.i.d. as antihypertensive monotherapy, were randomized to receive the selective 'calcium antagonist' felodipine 5 mg b.i.d. or hydrochlorothiazide 12.5 mg b.i.d. in addition to metoprolol 50 mg b.i.d. The trial duration was 8 weeks, the dose of the felodipine or hydrochlorothiazide being doubled after 4 weeks if 'control' of BP (dBP less than 90 mmHg) was not achieved on the initial doses. Over the trial period of 8 weeks, felodipine reduced dBP from 102 to 85 mmHg and hydrochlorothiazide from 101 to 91 mmHg; the dBP reduction in the felodipine group was greater than that in the hydrochlorothiazide group (17 vs 9 mmHg) and the attained dBP lower in the felodipine group. About half of the patients in each group required the higher dose. Both regimes were effective and well tolerated. In the dosages used, felodipine was a slightly more effective antihypertensive drug than hydrochlorothiazide when added to metoprolol. There was no apparent difference in the tolerability of the two regimes.
76例在全科医疗中接受治疗的单纯性高血压患者，在使用美托洛尔50毫克每日两次作为抗高血压单一疗法进行至少4周治疗后，其坐位舒张压（第五期）（dBP）仍大于或等于95毫米汞柱，被随机分配接受选择性“钙拮抗剂”非洛地平5毫克每日两次或氢氯噻嗪12.5毫克每日两次，同时继续使用美托洛尔50毫克每日两次。试验为期8周，如果初始剂量未能实现血压“控制”（dBP小于90毫米汞柱），则在4周后将非洛地平或氢氯噻嗪的剂量加倍。在8周的试验期内，非洛地平使dBP从102毫米汞柱降至85毫米汞柱，氢氯噻嗪使其从101毫米汞柱降至91毫米汞柱；非洛地平组的dBP降幅大于氢氯噻嗪组（分别为17毫米汞柱和9毫米汞柱），且非洛地平组达到的dBP更低。每组约一半的患者需要更高剂量。两种治疗方案均有效且耐受性良好。在所使用的剂量下，非洛地平与美托洛尔联用时作为抗高血压药物比氢氯噻嗪稍有效。两种治疗方案的耐受性没有明显差异。
