Comparison of a centrally acting antihypertensive agent and beta-adrenergic blocking agents for the treatment of hypertension.

Centrally acting agents and the beta-adrenergic antagonists represent two classes of antihypertensive agents recommended for initial monotherapy. Comparisons of the efficacy and safety of the centrally acting agent, guanabenz, with those of propranolol and pindolol in patients with mild to moderately severe hypertension, are reported. In the guanabenz versus propranolol study, mean supine blood pressure decreased by 19/15 mm Hg for 44 guanabenz-treated patients and by 17/15 mm Hg for 52 propranolol-treated patients who completed 6 months of therapy. In the guanabenz versus pindolol study, the mean decrease in supine blood pressure was 17/14 mm Hg for the 12 patients treated with guanabenz and 21/15 mm Hg for the 13 patients who received pindolol and completed 2 months of therapy. If the patients who discontinued therapy for drug-related reasons are considered, the percentages of patients with clinically satisfactory blood pressure reductions were 59% for the guanabenz group versus 62% for the propranolol group and 79% for guanabenz-treated patients versus 64% for pindolol-treated patients. Although adverse effects, including dry mouth, drowsiness, and weakness, were more common among guanabenz-treated patients, these effects generally were mild and became less frequent with continued therapy. The therapeutic efficacy and safety of guanabenz were similar to those of the two beta-adrenergic blocking drugs, propranolol and pindolol. Guanabenz therapy decreased serum total cholesterol (p less than 0.05), whereas propranolol therapy decreased HDL cholesterol (p less than 0.05). Thus, guanabenz did not produce serum lipid abnormalities that may be associated with increased cardiovascular risk.(ABSTRACT TRUNCATED AT 250 WORDS)