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September 1991

A Randomized Controlled Trial of the Effects of Three Antihypertensive Agents on Blood Pressure Control and Quality of Life in Older Women

Author Affiliations

From the University of Tennessee, Memphis (Dr Applegate); Columbiana (Ala) Associates (Dr Phillips); the University of Alabama at Birmingham (Dr Schnaper); the University of Texas Health Sciences Center at San Antonio (Dr Shepherd); the University of South Florida, Tampa (Dr Schocken); the University of North Carolina, Chapel Hill (Dr Koch); Marion Merrell Dow Inc, Kansas City, Mo (Dr Park); Dr Luhr is in private practice in Forest Hills, NY. A complete listing of participants in this multicenter study appears at the end of this article.

Arch Intern Med. 1991;151(9):1817-1823. doi:10.1001/archinte.1991.00400090099018

We conducted a multicenter, randomized, double-blind, parallel group trial to compare the impact of titrated doses of atenolol (50 to 100 mg once a day), enalapril (5 to 20 mg once a day), and diltiazem (sustained release) (60 to 180 mg twice a day) on blood pressure and quality of life in older hypertensive women. Two hundred forty-two patients were randomized. Dose titration was completed by week 4 after randomization, and the maintenance phase was completed at week 16. Diltiazem (sustained release) demonstrated greater diastolic blood pressure lowering at both weeks 8 and 16 by an intent-to-treat analysis. At week 16, diltiazem changed diastolic blood pressure -13.7±0.7 mm Hg compared with -10.8±1.1 mm Hg for atenolol, and -10.5±0.9 mm Hg for enalapril. Diltiazem also demonstrated greater lowering of systolic blood pressure at week 8, but these differences in systolic blood pressure had decreased by week 16. More patients were classified as treat. ment failures during the 16 weeks of the trial for atenolol (15%) than for diltiazem (2.5%), while the treatment failure rate was intermediate with enalapril (8%). Total rates of adverse events were equivalent across the three treatment arms. There were few significant differences in the impact of the three treatments on mean scores of quality-of-life measures at week 16. There was a trend for atenolol to have somewhat worse quality-of-life scores, but none of these differences were statistically significant. In conclusion, all three treatment regimens were effective in lowering diastolic blood pressure without significant differences in rates of adverse events or deleterious effects on quality of life.

(Arch Intern Med. 1991;151:1817-1823)

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