Long-term follow-up study of hypertensive patients by practicing internists after a controlled drug trial.

Thirty patients with uncomplicated essential hypertension were treated for an average of 44 months by 14 internists in private practice. All patients had previously participated in a controlled comparative trial of antihypertensive drugs carried out by the same physicians in their offices. During the long-term follow-up period, ie, after completion of the initial trial, the physicians administered antihypertensive therapy based on their best judgment; the drugs they most commonly prescribed were diuretics (80% of patients) and beta-blocking agents (60% of patients). Although 80% of the patients received at least two different antihypertensive agents, diastolic pressures fell below 96 mmHg in approximately 60% of the patients and below 90 mmHg in only a small fraction. Thus it appears that it is not easy for physicians in private practice to optimally reduce blood pressure levels in hypertensive patients despite the availability of numerous antihypertensive drugs. The tendency of practitioners to approximate blood pressure levels to multiples of 5 or even 10 mmHg may be partially responsible for the unsatisfactory results.

[Evaluation by practicing physicians of the antihypertensive efficacy of debrisoquin, methyldopa and propranolol]. / Evaluation par des médecins installés de l'efficacité antihypertensive de la débrisoquine, de la méthyldopa et du propranolol.

The antihypertensive effect of debrisoquine (20 mg/day), methyldopa (100 mg/day) and propranolol (160 mg/day) was compared to that obtained with a placebo in a controlled trial carried out by a group of 14 internists. Forty-eight patients with uncomplicated essential hypertension were included. Mefruside (25 mg/day) was first given alone for 6 weeks ("open phase" of the trial) and to this diuretic was then added in double-blind fashion and randomized sequence a placebo or an active drug. Each of the 4 blind phases lasted 4 weeks. At the end of the "open phase", blood pressure in seated position averaged 168/111 +/- 19.6/13.5 mm Hg (mean +/- SD). A significant blood pressure decrease was observed after 4 weeks of treatment with the placebo as well as with the investigated compounds. With the placebo blood pressure was reduced to 158/102 +/- 19.6/13.5 mm Hg (p less than 0.001). The magnitude of the additional blood pressure decrease induced by the active drugs was relatively small and varied from 4 (debrisoquine) to 10 mm Hg (methyldopa, p less than 0.01) for the systolic and from 3 (debrisoquine, p less than 0.05) to 5 mm Hg (propranolol, p less than 0.05) for the diastolic. The percentage of patients with systolic pressure of less than or equal to 140 mm Hg and with diastolic pressure of less than 90 mm Hg during administration of either drug was not greater than 40 to 20% respectively. Propranolol appeared to be better tolerated than the other antihypertensive agents. These rather disappointing blood pressure results suggest that the efficacy of antihypertensive agents in private practice cannot be extrapolated from studies carried out in specialized hypertension clinics.