Comparison of efficacy and adverse events among four antihypertensive drugs in rural hypertensive patients

Objective:To compare the efficacy and tolerability of 4 antihypertensive drugs after 4-week's monotherapy in untreated rural hypertensive patients in China.Method:A total of 3 408 untreated patients (66% women) aged 40 to 75 years were enrolled from 7 communities in XinYang County from March to May in 2005. Patients were randomized to 1 of 4 treatments-atenolol (12.5-25 mg/d) group of 594,or hydrochlorothiazide (12.5-25 mg/d) of 891,or nifedipine sustained release (20-40 mg/d) of 947,or captopril (25-50 mg/d) of 976,respectively. After 4 weeks treatment,the mean reduction in blood pressure and adverse events were assessed.Result:On week 4,the control goal rates were 44.5% for systolic and 56.2% for diastolic pressure as a whole. The control goal rates for systolic blood pressure were significantly higher in hydrochlorothiazide and nifedipine SR than in atenolol and captopril groups in both male and female patients (both P0.001). After adjustment for age,blood glucose,drug doses and pretreatment blood pressure,the mean reductions in systolic pressure were significantly greater in hydrochlorothiazide ([18.7±1.2]mmHg) and Nifedipine ([20.9±1.3]mmHg) than atenolol ([11.2±1.5]mmHg) and captopril ([15.7±1.1]mmHg) (P0.001) in male patients and similar results were observed in female patients. The mean reduction in diastolic pressure was significantly lower in captopril group both in male and female patients (P0.001). Total adverse events were significantly lower in hydrochlorothiazide (4.62%) than atenolol (11.1%),nifedipine (8.03%),and captopril (7.52%) (P0.001).Conclusion:Our results support that low dose hydrochlorothiazide is suitable as the first line antihypertensive treatment in developing countries due to its significantly higher efficacy,better tolerability,and lower cost.