Initial therapy of essential hypertension: diuretic or beta blocker?

The ability of hydrochlorothiazide or a long-acting beta adrenergic blocker, nadolol, to reduce the blood pressure was compared in 55 patients with mild to moderately severe essential hypertension. A randomized crossover study design was employed, with 43 patients completing both legs of the study. The mean sitting diastolic blood pressures after one month of therapy were reduced by 13.6 and 14.9 mmHg with hydrochlorothiazide and nadolol, respectively. After hydrochlorothiazide therapy, the diastolic blood pressure was 90 mmHg or lower in 51 percent of the patients, and after nadolol, in 56 percent of the same patients. The results suggest that diuretics and beta adrenergic blockers are equally effective in lowering the blood pressure. Nadolol's long duration of beta adrenoreceptor blockade justifies a simplified, once daily dosage schedule.