Scot. meet. J., 1976, 21: 28
OXPRENOLOL IN HYPERTENSION: A REPORT ON 2,770 PATIENTS IN GENERAL PRACTICE ORIGINALLY TREATED WITH METHYLDOPA
W. A. Forrest Senior Medical Adviser, elBA Laboraroties, Horsham, Sussex
Summary. Substitution, in part or totally, of the non-selective l3-receptor antagonist oxprenolol for methyldopa in 2,770 treated hypertensive patients resulted in a significant reduction in blood pressure levels and a considerable improvement in the quality of the patient's life. N a recent study in poorly responsive
patients treated with methylIdopahypertensive (Murphy et al., 1974), oxprenolol was
added to the daily dose of methyldopa. This led to a reduction in blood pressure levels but side effects continued to contribute to the problems of treatment. This study was designed to examine the feasibility of substituting, rather than adding, oxprenolol for methyldopa in a similar group of patients, by studying the effects on blood pressure levels and on unwanted reactions. Physicians were asked to select up to 6 hypertensive patients in their practice being treated with methyldopa, whose blood pressure remained high in spite of treatment, who complained of troublesome side effects, or where both conditions applied. This report is based on 2,770 record forms from several hundred practices in the United Kingdom. Patient population In this group of 2,770 patients the female/male ratio was 1.2: 1, and the mean age 58.8 years ±9.8. Blood pressure was measured on 3 separate occasions, using a standard mercury sphygmomanometer, with the patient sitting or lying. The initial mean blood pressure, averaged over the 3 readings, was 186/110 mmHg. The median daily dose of methylJopa was 750 mg., ranging from 500 mg. to 2 g. daily. Fifty-eight per cent of the patients complained of side effects with treatment, of which tiredness was the most commonly reported.
The study On entry, the patient was prescribed oxpren0101 80 mg. daily for one week, in addition to the prescribed dose of methyldopa. During
the second week the daily dose of oxprenolol was increased to 160 mg. daily (one 80 mg. tablet twice daily) with a recommended gradual reduction in the dose of methyldopa. Patients were then seen at intervals of the physician's choice to measure blood pressure, to assess tolerability and to titrate the dose of methyldopa and oxprenolol with the aim of reducing the sitting or lying diastolic blood pressure to a level of 95 mmHg. or less. The dose of oxprenolol could be gradually increased to a recommended maximum of 480 mg. daily with an accompanying reduction in methyldopa dosage. Although no time limits were laid down in this study about 85 per cent of physicians took, on average, 3 months to adjust the dosage of both compounds. At the final visit the patient reported subjectively on his altered regimen.
Results Systolic and diastolic blood pressures were significantly lower after the introduction of oxprenolol into treatment (Fig. 1). The incidence of unwanted side effects was markedly decreased (shown in Table I) and the great majority of patients reported a subjective improvement with this treatment (Table II). The reduction in daily methyldopa dosage, with complete withdrawal of this drug in over 40 per cent of the group is illustrated in Figure 2. At the end of the study the median daily dose of oxprenolol was 160 mg. ranging from 80 to 480 mg. Withdrawals from the study are listed in Table III. Discussion The long term aim of antihypertensive therapy is to prevent the consequences of raised blood pressure. Controlled studies (Veterans Administrative Co-operative Study Group, 1967,
Downloaded from scm.sagepub.com at SAGE Publications on June 21, 2016
Oxprenolol in Hypertension
Table I. Comparison between side effects reported at initial and final assessments, showing the marked reduction when oxprenolol partially replaced methyldopa.
% reporting at Final assessment after oxprenolol
% reporting at Initial assessment on methyldopa
Symptom reported Tiredness Dizziness Depression Headache G-I disturbance Sexual problems
42 28 24 24
17* 10*
19
12*
6*
p
OXPRENOLOL IN HYPERTENSION: A REPORT ON 2,770 PATIENTS IN GENERAL PRACTICE ORIGINALLY TREATED WITH METHYLDOPA
W. A. Forrest Senior Medical Adviser, elBA Laboraroties, Horsham, Sussex
Summary. Substitution, in part or totally, of the non-selective l3-receptor antagonist oxprenolol for methyldopa in 2,770 treated hypertensive patients resulted in a significant reduction in blood pressure levels and a considerable improvement in the quality of the patient's life. N a recent study in poorly responsive
patients treated with methylIdopahypertensive (Murphy et al., 1974), oxprenolol was
added to the daily dose of methyldopa. This led to a reduction in blood pressure levels but side effects continued to contribute to the problems of treatment. This study was designed to examine the feasibility of substituting, rather than adding, oxprenolol for methyldopa in a similar group of patients, by studying the effects on blood pressure levels and on unwanted reactions. Physicians were asked to select up to 6 hypertensive patients in their practice being treated with methyldopa, whose blood pressure remained high in spite of treatment, who complained of troublesome side effects, or where both conditions applied. This report is based on 2,770 record forms from several hundred practices in the United Kingdom. Patient population In this group of 2,770 patients the female/male ratio was 1.2: 1, and the mean age 58.8 years ±9.8. Blood pressure was measured on 3 separate occasions, using a standard mercury sphygmomanometer, with the patient sitting or lying. The initial mean blood pressure, averaged over the 3 readings, was 186/110 mmHg. The median daily dose of methylJopa was 750 mg., ranging from 500 mg. to 2 g. daily. Fifty-eight per cent of the patients complained of side effects with treatment, of which tiredness was the most commonly reported.
The study On entry, the patient was prescribed oxpren0101 80 mg. daily for one week, in addition to the prescribed dose of methyldopa. During
the second week the daily dose of oxprenolol was increased to 160 mg. daily (one 80 mg. tablet twice daily) with a recommended gradual reduction in the dose of methyldopa. Patients were then seen at intervals of the physician's choice to measure blood pressure, to assess tolerability and to titrate the dose of methyldopa and oxprenolol with the aim of reducing the sitting or lying diastolic blood pressure to a level of 95 mmHg. or less. The dose of oxprenolol could be gradually increased to a recommended maximum of 480 mg. daily with an accompanying reduction in methyldopa dosage. Although no time limits were laid down in this study about 85 per cent of physicians took, on average, 3 months to adjust the dosage of both compounds. At the final visit the patient reported subjectively on his altered regimen.
Results Systolic and diastolic blood pressures were significantly lower after the introduction of oxprenolol into treatment (Fig. 1). The incidence of unwanted side effects was markedly decreased (shown in Table I) and the great majority of patients reported a subjective improvement with this treatment (Table II). The reduction in daily methyldopa dosage, with complete withdrawal of this drug in over 40 per cent of the group is illustrated in Figure 2. At the end of the study the median daily dose of oxprenolol was 160 mg. ranging from 80 to 480 mg. Withdrawals from the study are listed in Table III. Discussion The long term aim of antihypertensive therapy is to prevent the consequences of raised blood pressure. Controlled studies (Veterans Administrative Co-operative Study Group, 1967,
Downloaded from scm.sagepub.com at SAGE Publications on June 21, 2016
Oxprenolol in Hypertension
Table I. Comparison between side effects reported at initial and final assessments, showing the marked reduction when oxprenolol partially replaced methyldopa.
% reporting at Final assessment after oxprenolol
% reporting at Initial assessment on methyldopa
Symptom reported Tiredness Dizziness Depression Headache G-I disturbance Sexual problems
42 28 24 24
17* 10*
19
12*
6*
p
