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October 24, 1986, Vol 256, No. 16 >
ARTICLE | October 24, 1986

A Comparison of Verapamil and Propranolol for the Initial Treatment of Hypertension: Title and subTitle BreakRacial Differences in Response FREE

Luigi X. Cubeddu, MD, PhD; Juan Aranda, MD; Bramah Singh, MD, PhD; Michael Klein, MD; Jonas Brachfeld, MD; Edward Freis, MD; Jorge Roman, MD; Thomas Eades, MD
[+] Author Affiliations

Reprint requests to Division of Clinical Pharmacology, 906 Faculty Laboratory Office Bldg 231H, University of North Carolina, Chapel Hill, NC 27514 (Dr Cubeddu).


JAMA. 1986;256(16):2214-2221. doi:10.1001/jama.1986.03380160072023
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References

We compared verapamil and propranolol hydrochloride for monotherapy of hypertension. Verapamil lowered blood pressure (BP) more effectively than propranolol in black and white patients. Verapamil was equally effective in blacks and whites, whereas propranolol was more effective in whites. Heart rate was reduced by 6.0 beats per minute by verapamil, and by 13.6 beats per minute by propranolol. In blacks, verapamil lowered systolic BP 16.9 vs 8.1 mm Hg for propranolol; verapamil reduced diastolic BP 12.8 vs 8.6 mm Hg for propranolol. In whites, verapamil lowered systolic BP 19.0 vs 12.7 mm Hg for propranolol; verapamil reduced diastolic BP 16.7 vs 12.3 mm Hg for propranolol. Increases in systolic BP were observed in 22% and 3.4% of patients receiving propranolol and verapamil, respectively. The PR interval was increased from 163.5 to 174.9 ms for verapamil vs 160.3 to 164.4 ms for propranolol. Constipation (15%) and headaches (10%) were most frequent complaints for verapamil vs fatigue (18%) and dizziness (7%) for propranolol. Changes in blood biochemistry values were of small magnitude. We conclude that verapamil monotherapy is a safe and effective means of achieving BP control in patients with essential hypertension.

(JAMA 1986;256:2214-2221)

REFERENCES

1 +
Braunwald E:  Mechanism of action of calcium channel blocking agents . N Engl J Med 1982;; 307:1618-1627.
2 +
Halperin A, Cubeddu LX:  The role of calcium channel blockers in the treatment of hypertension . Am Heart J 1986;;111:363-382.
3 +
Hagino K:  Application of iproveratril in the pharmacotherapy of hypertension . Jpn J Clin Exp Med 1968;;45:208.
4 +
Cohn JN:  Calcium, vascular smooth muscle, and calcium entry blockers in hypertension . Ann Intern Med 1983;;98(pt (2) ):806-809.
5 +
Bohr DF, Webb RC:  Vascular smooth muscle function and its changes in hypertension . Am J Med 1984;;77:3-16.
6 +
Leonetti G, Cuspidi C, Sampieri L, et al:  Comparison of cardiovascular, renal, and humoral effects of acute administration of two calcium channel blockers in normotensive and hypertensive subjects . J Cardiovasc Pharmacol 1982;; 4( (suppl 3) ):S319-S324.
7 +
Hulthen VL, Bolli P, Amann FW:  Enhanced vasodilation in essential hypertension by calcium channel blockade with verapamil . Hypertension 1982;;4( (suppl 2) ):26-31.
8 +
Midtbo K, Hals O:  Verapamil in the treatment of hypertension . Curr Ther Res 1980;;27:830-838.
9 +
Hornung RS, Jones RI, Gould BA, et al:  A study of propranolol vs verapamil in the treatment of hypertension , abstracted. Proc of BPS , (Sept 7) -9, 1983;, pp 209P-210P.
10 +
Wigler I, Peer G, Soferman G, et al:  Long-term treatment of arterial hypertension with verapamil . Int J Clin Pharmacol 1984;;22:162-166.
11 +
Lewis GRJ, Morely KD, Lewis BM, et al:  The treatment of hypertension with verapamil . NZ Med J 1978;;87:351-354.
12 +
Buhler FR, Hulthen VL, Kiowski W:  The place of the calcium antagonist verapamil in hypertensive therapy . J Cardiovasc Pharmacol 1982;;4( (suppl 3) ):S350-S357.
13 +
Zawar PB, Chawhen RN, Gosasi PD, et al:  Verapamil in hypertension: A long-term study . Indian Heart J 1982;;34:38-41.
14 +
Anavekar SN, Barter C, Adam WR, et al:  A double-blind comparison of verapamil and labetalol in hypertensive patients with coexisting chronic obstructive airways disease . J Cardiovasc Pharmacol 1982;;4:S374-S377.
15 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents:  Comparison of propranolol and hydrochlorothiazide for the initial treatment of hypertension: I. Results of short term titration with emphasis on racial differences in responses . JAMA 1982;;248:22-29.
16 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents:  Comparison of propranolol and hydrochlorothiazide for the initial treatment of hypertension: II. Results of long-term therapy . JAMA 1982;;248:2004-2011.
17 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents:  Racial differences in response to low-dose captopril are abolished by the addition of hydrochlorothiazide . Br J Pharmacol 1982;;14:975-1015.
18 +
Stephen SA:  Unwanted effects of propranolol . Am J Cardiol 1966;;18:463-472.
19 +
The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure , publication 84-1088. US Dept of Health and Human Services, 1984;.
20 +
Buhler FR, Hulthen VL, Kiowski W:  The place of the calcium antagonist verapamil in hypertensive therapy . J Cardiovasc Pharmacol 1982;;4:S350-S357.
21 +
Erne P, Bolli P, Bertel O, et al:  Factors influencing the hypotensive effects of calcium antagonists . Hypertension 1983;;5:1197-102.
22 +
Aranda JM, Pedroza C, Rodriguez M, et al:  Long-term efficacy of verapamil in arterial hypertension: Blood pressure response during dynamic exercise after chronic therapy , abstracted. Clin Res 1984;;32:844A.
23 +
Frishman WH, Klein NA, Klein P, et al:  Comparison of oral propranolol and verapamil for combined systemic hypertension and angina pectoris: A placebo-controlled double-blind randomized crossover trial . Am J Cardiol 1982;;50:1164-1172.
24 +
Halperin AK, Gross KM, Rogers JF, et al:  Verapamil and propranolol in essential hypertension . Clin Pharmacol Ther 1984;;36:750-758.
25 +
Messerli FH, Carvaltto JGR, Christie B, et al:  Essential hypertension in black and white subjects: Hemodynamic findings and fluid volume state . Am J Med 1979;;67:27-31.
26 +
Chrysant SG, Danisa K, Kem DC, et al:  Racial differences in pressure, volume and renin interrelationships in essential hypertension . Hypertension 1979;;1:136-141.
27 +
Holland DB, Fairchild C:  Renin classification for diuretic and β-blocker treatment of black hypertensive patients . J Chronic Dis 1982;;35:179-182.
28 +
Voors AW, Dalferes ER, Frank GC, et al:  Relation between ingested potassium and sodium balance in young blacks and whites . Am J Clin Nutr 1983;;37:583-594.
29 +
Midtbo K, Hals O, van der Meer J:  Verapamil compared with nifedipine in the treatment of essential hypertension . J Cardiovasc Pharmacol 1982;;4:S363-S368.
30 +
Frohlich ED, Tarazi RC, Dustan HP, et al:  The paradox of β-adrenergic blockade in hypertension . Circulation 1968;;37:417-421.
31 +
Leren P, Helgeland A, Holma I, et al:  Effects of propranolol and prazosin on blood lipids: The Oslo study . Lancet 1980;;2:4-6.
32 +
Levy SB, Talner LB, Coel MN, et al:  Renal vasculature in essential hypertension: Racial differences . Ann Intern Med 1978;;88:12-16.

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1 +
Braunwald E:  Mechanism of action of calcium channel blocking agents . N Engl J Med 1982;; 307:1618-1627.
2 +
Halperin A, Cubeddu LX:  The role of calcium channel blockers in the treatment of hypertension . Am Heart J 1986;;111:363-382.
3 +
Hagino K:  Application of iproveratril in the pharmacotherapy of hypertension . Jpn J Clin Exp Med 1968;;45:208.
4 +
Cohn JN:  Calcium, vascular smooth muscle, and calcium entry blockers in hypertension . Ann Intern Med 1983;;98(pt (2) ):806-809.
5 +
Bohr DF, Webb RC:  Vascular smooth muscle function and its changes in hypertension . Am J Med 1984;;77:3-16.
6 +
Leonetti G, Cuspidi C, Sampieri L, et al:  Comparison of cardiovascular, renal, and humoral effects of acute administration of two calcium channel blockers in normotensive and hypertensive subjects . J Cardiovasc Pharmacol 1982;; 4( (suppl 3) ):S319-S324.
7 +
Hulthen VL, Bolli P, Amann FW:  Enhanced vasodilation in essential hypertension by calcium channel blockade with verapamil . Hypertension 1982;;4( (suppl 2) ):26-31.
8 +
Midtbo K, Hals O:  Verapamil in the treatment of hypertension . Curr Ther Res 1980;;27:830-838.
9 +
Hornung RS, Jones RI, Gould BA, et al:  A study of propranolol vs verapamil in the treatment of hypertension , abstracted. Proc of BPS , (Sept 7) -9, 1983;, pp 209P-210P.
10 +
Wigler I, Peer G, Soferman G, et al:  Long-term treatment of arterial hypertension with verapamil . Int J Clin Pharmacol 1984;;22:162-166.
11 +
Lewis GRJ, Morely KD, Lewis BM, et al:  The treatment of hypertension with verapamil . NZ Med J 1978;;87:351-354.
12 +
Buhler FR, Hulthen VL, Kiowski W:  The place of the calcium antagonist verapamil in hypertensive therapy . J Cardiovasc Pharmacol 1982;;4( (suppl 3) ):S350-S357.
13 +
Zawar PB, Chawhen RN, Gosasi PD, et al:  Verapamil in hypertension: A long-term study . Indian Heart J 1982;;34:38-41.
14 +
Anavekar SN, Barter C, Adam WR, et al:  A double-blind comparison of verapamil and labetalol in hypertensive patients with coexisting chronic obstructive airways disease . J Cardiovasc Pharmacol 1982;;4:S374-S377.
15 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents:  Comparison of propranolol and hydrochlorothiazide for the initial treatment of hypertension: I. Results of short term titration with emphasis on racial differences in responses . JAMA 1982;;248:22-29.
16 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents:  Comparison of propranolol and hydrochlorothiazide for the initial treatment of hypertension: II. Results of long-term therapy . JAMA 1982;;248:2004-2011.
17 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents:  Racial differences in response to low-dose captopril are abolished by the addition of hydrochlorothiazide . Br J Pharmacol 1982;;14:975-1015.
18 +
Stephen SA:  Unwanted effects of propranolol . Am J Cardiol 1966;;18:463-472.
19 +
The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure , publication 84-1088. US Dept of Health and Human Services, 1984;.
20 +
Buhler FR, Hulthen VL, Kiowski W:  The place of the calcium antagonist verapamil in hypertensive therapy . J Cardiovasc Pharmacol 1982;;4:S350-S357.
21 +
Erne P, Bolli P, Bertel O, et al:  Factors influencing the hypotensive effects of calcium antagonists . Hypertension 1983;;5:1197-102.
22 +
Aranda JM, Pedroza C, Rodriguez M, et al:  Long-term efficacy of verapamil in arterial hypertension: Blood pressure response during dynamic exercise after chronic therapy , abstracted. Clin Res 1984;;32:844A.
23 +
Frishman WH, Klein NA, Klein P, et al:  Comparison of oral propranolol and verapamil for combined systemic hypertension and angina pectoris: A placebo-controlled double-blind randomized crossover trial . Am J Cardiol 1982;;50:1164-1172.
24 +
Halperin AK, Gross KM, Rogers JF, et al:  Verapamil and propranolol in essential hypertension . Clin Pharmacol Ther 1984;;36:750-758.
25 +
Messerli FH, Carvaltto JGR, Christie B, et al:  Essential hypertension in black and white subjects: Hemodynamic findings and fluid volume state . Am J Med 1979;;67:27-31.
26 +
Chrysant SG, Danisa K, Kem DC, et al:  Racial differences in pressure, volume and renin interrelationships in essential hypertension . Hypertension 1979;;1:136-141.
27 +
Holland DB, Fairchild C:  Renin classification for diuretic and β-blocker treatment of black hypertensive patients . J Chronic Dis 1982;;35:179-182.
28 +
Voors AW, Dalferes ER, Frank GC, et al:  Relation between ingested potassium and sodium balance in young blacks and whites . Am J Clin Nutr 1983;;37:583-594.
29 +
Midtbo K, Hals O, van der Meer J:  Verapamil compared with nifedipine in the treatment of essential hypertension . J Cardiovasc Pharmacol 1982;;4:S363-S368.
30 +
Frohlich ED, Tarazi RC, Dustan HP, et al:  The paradox of β-adrenergic blockade in hypertension . Circulation 1968;;37:417-421.
31 +
Leren P, Helgeland A, Holma I, et al:  Effects of propranolol and prazosin on blood lipids: The Oslo study . Lancet 1980;;2:4-6.
32 +
Levy SB, Talner LB, Coel MN, et al:  Renal vasculature in essential hypertension: Racial differences . Ann Intern Med 1978;;88:12-16.

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