Advertisement

Double-blind trial comparing labetalol with atenolol in the treatment of systemic hypertension with angina pectoris

  • Larry D. Jee
    Affiliations
    From the Ischaemic Heart Disease Research Unit of the Medical Research Council, and the University of Cape Town, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
    Search for articles by this author
  • Lionel H. Opie
    Correspondence
    Address for reprints: Lionel H, Opie, MD, PhD, Heart Research Unit, Department of Medicine, University of Cape Town Medical School, Observatory 7925, South Africa.
    Affiliations
    From the Ischaemic Heart Disease Research Unit of the Medical Research Council, and the University of Cape Town, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Some theoretical arguments suggest that added vasodilation could be beneficial in the management of patients with systemic hypertension and angina pectoris. Ten patients were studied in a double-blind crossover trial in which the severity of hypertension and angina pectoris was monitored. The initial run-in period of 2 to 6 weeks consisted of therapy with fixed-dose atenolol, 100 mg once daily, a thiazide diuretic drug, and any other agents required to control the hypertension. Patients were then randomized for 4 weeks to active atenolol plus 2 tablets of labetalol placebo, or active labetalol (200 mg twice daily) plus atenolol placebo, then crossed over and then changed back to active atenolol without labetalol placebo; the observers were unblinded in the last period. Labetalol and atenolol were equivalent in control of blood pressure at rest, exercise tolerance and use of nitroglycerin; however, heart rates at rest and during exercise were higher with labetalol (p < 0.01), whereas the heart rate-blood pressure product at the end of the exercise test was unchanged with labetalol. The higher heart rates for the same antianginal efficacy may give an advantage to labetalol treatment in some patients. Conversely, atenolol is cardioselective, hydrophilic, and can be given as a single daily dose. Thus, each agent has some advantages in the therapy of patients with hypertension and effort angina.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Maseri A.
        • l'Abbate A.
        • Pesola A.
        • Ballestra A.M.
        • Marzill M.
        • Maltinti G.
        • Severl S.
        • De Nes D.M.
        • Parodi O.
        • Biagini A.
        Coronary vasospasm in angina pectoris.
        Lancet. 1977; 1: 713-717
        • Chierchia S.
        • Gallino A.
        • Smith G.
        • Deanfield J.
        • Morgan M.
        • Croom M.
        • Maseri A.
        Role of heart rate in pathophysiology of chronic stable angina.
        Lancet. 1984; 2: 1353-1357
        • Frishman W.H.
        • Klein N.A.
        • Klein P.
        • Strom J.A.
        • Tawil R.
        • Strair R.
        • Wong B.
        • Roth S.
        • LeJemtel T.H.
        • Pollack S.
        • Sonnenblick E.H.
        Comparison of oral propranolol and verapamil for combined systemic hypertension and angina pectoris.
        Am J Cardiol. 1982; 50: 1164-1172
        • Wallin J.D.
        • O'Neill Jr., W.M.
        Labetalol, current research and therapeutic status.
        Arch Intern Med. 1983; 143: 485-490
        • Ibrahim M.M.
        • Mossaliam R.
        Clinical evaluation of atenolol in hypertensive patients.
        Circulation. 1981; 64: 368-374
        • Schwartz J.B.
        • Jackson G.
        • Kates R.E.
        • Harrison D.C.
        Long-term benefit of cardioselective beta blockade with once-daily atenolol therapy in angina pectoris.
        Am Heart J. 1981; 101: 380-385
        • Lubbe W.F.
        • White D.A.
        Labetalol in hypertensive patients with angina pectoris: beneficial effect of combined alpha- and beta-blockade.
        Clin Sci Mol Med. 1978; 55: 283S-286S
        • Halprin S.
        • Frishman W.
        • Kirschner M.
        • Strom J.
        Clinical pharmacology of the new beta-adrenergic blocking drugs. Part II. Effects of oral labetalol in patients with both angina pectoris and hypertension: a preliminary experience.
        Am Heart J. 1980; 99: 388-396
        • Besterman E.M.M.
        • Spencer M.
        Open evaluation of labetalol in the treatment of angina pectoris occurring in hypertensive patients.
        Br J Clin Pharmacol. 1979; 8: 205S-209S
        • Ople L.H.
        • White D.
        • Jee L.
        Alternatives to beta-blockade in therapy of hypertension with angina pectoris: role of nifedipine or of labetalol.
        Br J Clin Pharmacol. 1982; 13: 115S-122S
        • Frishman W.H.
        • Klein N.A.
        • Strom J.A.
        • Cohen M.N.
        • Shamoon H.
        • Willens H.
        • Klein P.
        • Roth S.
        • Iorio L.
        • LeJemtel T.H.
        • Pollack S.
        • Sonnenblick E.H.
        Comparative effects of abrupt withdrawal of propranolol and verapamil in angina pectoris.
        Am J Cardiol. 1982; 50: 1191-1195
        • Ades P.A.
        • Bramell H.L.
        • Greenberg J.H.
        • Horwitz L.D.
        Effect of beta blockade and intrinsic sympathomimetic activity on exercise performance.
        Am J Cardiol. 1984; 54: 1337-1341
        • Opie L.H.
        • Jee L.
        • White D.
        Antihypertensive effects of nifedipine combined with cardioselective beta-adrebergic receptor antagonism by atenolol.
        Am Heart J. 1982; 104: 606-612