EFFICACY AND SAFETY OF ATENOLOL, ENALAPRIL, AND ISRADIPINE IN ELDERLYHYPERTENSIVE WOMEN

PURPOSE: This trial was designed to evaluate the efficacy and safety o f three different classes of antihypertensive agents in elderly women. PATIENTS AND METHODS: The trial had three phases: 4 to 8 weeks of pla cebo, 6 weeks of titration, and 16 weeks of maintenance. White women b etween 60 and 80 years old with sitting diastolic blood pressures (DBP s) from 95 through 114 mm Hg treated with placebo were evaluated by hi story, physical examination, laboratory studies, and quality-of-life i nterview. After double-blind randomization with low-dose atenolol, ena lapril, or isradipine, the dose was increased stepwise and hydrochloro thiazide added as needed to achieve goal DBP (less than 90 mm Hg and g reater than 10 mm Hg below baseline). During maintenance, patients not at goal were ''stepped up,'' and patients with uncontrolled DBP at ma ximum dosage were removed from the study. The pretreatment (baseline) blood pressure of the 315 randomized participants averaged 161/100 mm Hg; 92% had been treated previously for hypertension, 15% had diabetes mellitus, 11% smoked, and 38% consumed alcohol. RESULTS: For 245 pati ents completing the trial, the average decrease in blood pressure duri ng treatment was 18.2/15.6 mm Hg. Antihypertensive efficacy was simila r for the monotherapy drug regimens, with 84%, 71%, and 80% of patient s receiving atenolol, enalapril, and isradipine, respectively, achievi ng DBP goal. Of the 70 patients who did not complete the trial, 42 lef t because of symptoms and 19 because of uncontrolled DBP. No important , unexpected drug-induced changes in symptbms or blood chemistries wer e noted. Symptom frequency differed little among the three dosage leve ls, becoming maximal by the second visit at the same dosage level. CON CLUSION: All three drugs lowered DBP comparably, and none produced ala rming effects. Thirteen percent of patients left the study because of symptoms.