DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20172730

Prospective, randomized double blind comparative study of safety and efficacy of carvedilol versus atenolol in patients of mild to moderate hypertension

Swathi Ratnam R., Usha Kiran P., S. V. R. Rajasekhar, M. Prasad Naidu

Abstract


Background: Carvedilol is a new cardiovascular compound with the combined pharmacologic properties of nonselective ß-blockade and vasodilation. The Aim of the study was to compare the safety and antihypertensive efficacy of 25mg Carvedilol once daily with 50mg atenolol once daily in patients with mild to moderate essential hypertension.

Methods: This was a single center study conducted in Rangaraya Medical College, Kakinada. 80 eligible patients with mild to moderate hypertension were randomized to receive 25mg Carvedilol once daily (40 patients) or 50mg atenolol (40 patients) in a double-blind 12-week treatment phase. At each visit 0, 4, 8 and 12 weeks of treatment, sitting Blood Pressure (BP) and heart rate were measured. The effect on BP reduction within the group is compared by paired “t”test and the effect on reduction of BP between two study groups compared by unpaired “t”test.

Results: After 12 weeks of treatment, the mean reduction of SBP (Systolic Blood Pressure) with carvedilol is 22.33±8.31mmHg with no Significant difference (p >0.05) compared to atenolol group mean reduction in SBP of 21.37±10mm Hg. The mean reduction in DBP (Diastolic Blood Pressure) after completion of the study in carvedilol group is 6.75±4.82mm Hg with no Significant difference (p >0.05) compared to atenolol group mean reduction in DBP of 8.55±5.25mm Hg. No significant difference seen in the efficacy parameters of both the drugs. The incidence of adverse effects such as bradycardia, headache, nausea, vomiting, hypotension and rash is less with carvedilol.

Conclusions: In patients with mild to moderate hypertension, there was no statistically significant difference between efficacy of carvedilol or atenolol with regard to the degree of reduction in BP or the percentage of patients achieving a response to therapy but carvedilol showed a better safety profile when compared to atenolol.


Keywords


Atenolol, Blood pressure, Carvedilol, Essential hypertension

Full Text:

PDF

References


Redon J. Hypertension and the metabolic syndrome. Manual of Hypertension of the European Society of Hypertension. 2008 Sep:303.

Chae CU, Pfeffer MA, Glynn RJ, Mitchell GF, Taylor JO, Hennekens CH. Increased pulse pressure and risk of heart failure in the elderly. Jama. 1999 Feb;281(7):634-43.

Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney international. 2005 Jun;67(6):2089-100.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. hypertension. 2003 Dec;42(6):1206-52.

Biradar SS, Reddy S, Raju SA, Kapatae R. Assessment of pharmacist mediated patient counseling on knowledge, attitude and practices on hypertension in compliance with antihypertensive drugs in South Indian city. International Journal of Pharmacy and Life Sciences. 2012 Jun;3(6).

Prince MJ, Ebrahim S, Acosta D, Ferri CP, Guerra M, Huang Y, et al. Hypertension prevalence, awareness, treatment and control among older people in Latin America, India and China: a 10/66 cross-sectional population-based survey. Journal of hypertension. 2012 Jan 1;30(1):177-87.

Ruilope LM. Comparison of a new vasodilating β-blocker, carvedilol, with atenolol in the treatment of mild to moderate essential hypertension. American journal of hypertension. 1994 Feb;7(2):129-36.

Yancy CW, Fowler MB, Colucci WS, Gilbert EM, Bristow MR, Cohn JN, et al. Race and the response to adrenergic blockade with carvedilol in patients with chronic heart failure. New England Journal of Medicine. 2001 May;344(18):1358-65.

Wang L, Manson JE, Sesso HD. Calcium intake and risk of cardiovascular disease. American Journal of Cardiovascular Drugs. 2012 Apr;12(2):105-16.

Gupta R. Trends in hypertension epidemiology in India. Journal of human hypertension. 2004 Feb;18(2):73-8.

Prospective Studies Collaboration. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55 000 vascular deaths. The Lancet. 2007 Dec 7;370(9602):1829-39.

De la Sierra A, Segura J, Banegas JR, Gorostidi M, Juan J, Armario P, et al. Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension. 2011 May 1;57(5):898-902.

Young PH. A comparison of carvedilol with atenolol in the treatment of mild-to-moderate essential hypertension journal of cardiovascular pharmacology. 1992;19.

Widmann, L, van der Does R, Hörrmann M. Eur J Clin Pharmacol. 1990;38(2):143.