COMPARISON OF BISOPROLOL WITH ATENOLOL FOR SYSTEMIC HYPERTENSION IN 4POPULATION GROUPS (YOUNG, OLD, BLACK AND NONBLACK) USING AMBULATORY BLOOD-PRESSURE MONITORING

The antihypertensive effects of drugs are partly determined by charact eristics of the patients treated. A randomized, double-blind study use d 24-hour ambulatory blood Pressure (BP) monitoring to compare the eff ects of 2 beta blockers-, bisoprolol (10 to 20 mg; n = 107) and atenol ol (50 to 100 mg; n = 96), administered once daily in 4 population gro ups. After a 4-week placebo period, patients with an office diastolic BP between 95 and 114 mm Hg were stratified according to race and age, and were randomly assigned to treatment with bisoprolol or atenolol f or 8 weeks. BP averages measured by automated monitoring for the 24-ho ur periods were compared between groups. in elderly patients, the redu ctions in both average 24-hour systolic and diastolic BP were greater with bisoprolol than with atenolol (13 +/- 3/13 +/- 1 mm Hg [n = 231 v s 4 +/- 2/6 +/- 1 mm Hg, n +/- 301; p <0.01). Similarly, bisoprolol pr oduced greater reductions in average 24-hour diastolic BP than did ate nolol in nonblack patients (16 +/- 2/12 +/- 1 mm Hg [n = 85] vs 12 +/- 2/9 +/- 1 mm Hg [n = 83]; p = 0.02). Bisoprolol and atenolol were sim ilar in the black (10 +/- 5/9 +/- 3 mm Hg [n = 22] and 10 +/- 6/6 +/- 3 mm Hg In = 131, respectively) and young (15 +/- 1/11 +/- 1 mm Hg [n = 84] and 16 +/- 2/10 +/- 1 mm Hg [n = 66], respectively) groups. Thus , whereas bisoprolol had equal efficacy in older and younger age group s, atenolol was less effective in the elderly than in the young. The d ifference between the drugs in antihypertensive effects occurred despi te similar beta blockade, as measured by decreases in heart rate. This suggests that drugs within a class of antihypertensive agents can hav e differing efficacies in separate population groups.