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October 24, 1986

A Comparison of Verapamil and Propranolol for the Initial Treatment of Hypertension: Racial Differences in Response

Author Affiliations

From the Division of Clinical Pharmacology, University of North Carolina, Chapel Hill (Dr Cubeddu); the Cardiology Service, Veterans Administration Hospital, San Juan, Puerto Rico (Dr Aranda); the Division of Cardiology, Wadsworth Veterans Administration Hospital, San Francisco (Dr Singh); Coronary Care, Boston University Medical Center, Boston (Dr Klein); Brachfeld Medical Associates, Zurgrugg Memorial Hospital, Willingboro, NJ (Dr Brachfeld); the Veterans Administration Hospital, Washington, DC (Dr Freis); the Renal Unit, Veterans Administration Medical Center, Salem, Va (Dr Roman); and Cardiovascular Associates, San Antonio, Tex (Dr Eades).

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

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)