A double-blind comparison of bisoprolol and captopril for treatment of essential hypertension in the elderly

The aim of the study was to compare the antihypertensive efficacy and safety of a new beta blocker with high beta1 selectivity, bisoprolol, with captopril in 28 elderly patients, aged over 65 years, with mild-to-moderate essential hypertension (WHO classes I and II). After a placebo run-in period of 4 weeks, the patients were randomly allocated to receive bisoprolol (5 mg od) or captopril (25 mg bid) doubledummy technique) for 6 weeks, according to a crossover double-blind design, with a 4-week washout period between the two active treatments. The doses were doubled after 2 weeks if the supine blood pressure was >160/95 mmHg. In basal conditions and after 2, 4, and 6 weeks of each treatment, the blood pressure and heart rate were assessed both in the supine and erect positions. At the same time, the side effects and quality of life were investigated by a checklist and a selfassessment questionnaire. Standard laboratory tests and a resting ECG tracing were performed before and after each active treatment. The data from 24 patients (4 dropouts) showed a significant antihypertensive effect of both treatments (p<0.01) with a reduction of diastolic blood pressure to values ≤95 mmHg in 75% (18/24) of the patients treated with bisoprolol and in 83.3% (20/24) of those treated with captopril, without significant differences between the two drugs. Bisoprolol also produces a marked but symptom-free reduction of heart rate compared with captopril (p<0.05). Neither the beta blocker nor the ACE inhibitor caused important side effects or worsening of the patients' quality of life, and no changes in laboratory tests and ECG tracings were observed. In conclusion, bisoprolol demonstrated antihypertensive action and tolerability comparable with captopril, and it is a suitable treatment in elderly hypertensive patients.