Treatment of Hypertension with Propranolol

When used in the treatment of hypertension propranolol is at least of similar potency to bethanidine, guanethidine, and methyldopa. Propranolol does not produce postural or exercise hypotension and it seems that it is often more acceptable to patients than conventional drugs. It usually produces the best control of the supine blood pressure.A series of 109 hypertensive patients was treated with propranolol; in nine the drug was withdrawn. In 92 of the patients a supine or standing blood pressure of 100 mm. Hg or less was achieved. Eighty of the patients had previously been treated with other potent drugs, and close comparisons and prolonged follow-up in 17 patients showed that diastolic pressures of 100 mm. Hg or less were achieved in more patients after propranolol than with guanethidine, bethanidine, or methyldopa.Sensitivity to propranolol varies widely, and dosage should be increased gradually. The hypotensive effect often takes six to eight weeks to reach its maximum. Propranolol reduces cardiac output but may also act by reducing the cardiac component of pressor stimuli; as a result the baroreceptors gradually regulate the blood pressure at a lower level. It is contraindicated in patients with obstructive airways disease or in uncompensated heart failure.     

Treatment of Hypertension with Hydrochlorothiazide and Spironolactone

A comparison was made of the antihypertensive effect of a daily dose of 150 mg. of hydrochlorothiazide (HCT) with one of 150 mg. of spironolactone (SL) in 48 patients with essential hypertension.The blood pressure values after six weeks of therapy with HCT were not significantly different from those after SL. Treatment of 25 of these patients with the two agents combined did not reduce the blood pressure further. Blood urea nitrogen concentrations increased with both HCT and SL treatment.With combined treatment there was a further increase in blood urea nitrogen concentration and a decrease in serum sodium concentrations without weight loss beyond that achieved with either HCT or SL alone.