Step 2 Regimens in Hypertension: An Assessment

A single-blind clinical trial compared step 2 combination therapy consisting of 50 or 100 mg of hydroflumethiazide plus either 0.125 to 0.250 mg of reserpine, 500 to 2,000 mg of methyldopa, or 80 to 320 mg of propranolol hydrochloride, in 59 patients whose elevated blood pressure (BP) failed to respond adequately to the thiazide alone. After nine weeks of treatment, diastolic BP was reduced below 90 mm Hg in all 20 patients treated with the reserpine-hydroflumethiazide combination, in 13 of the 19 patients treated with methyldopa and hydroflumethiazide, and in 16 of the 20 patients treated with propranolol and hydroflumethiazide. Changes in laboratory values were not substantial; adverse reactions occurred only in the methyldopa group. Although the three treatment regimens were similar with respect to safety and efficacy, the reserpine-hydroflumethiazide combination offers the advantages of more convenient dosage at lower cost. ( JAMA 241:579-581, 1979)