Comparison of acebutolol with and without hydrochlorothiazide versus carvedilol with and without hydrochlorothiazide in black patients with mild to moderate systemic hypertension

In the present study, we assessed the antihypertensive efficacy of acebutolol 200 mg versus carvedilol 25 mg once daily, given as monotherapy for 3 months to 40 black patients (20 patients in each group, mean age 53 ± 10 years, 24 women) with mean blood pressure (BP) during the day >90 and <110 mm Hg. Patients in whom blood pressure could not be controlled took medication, which was increased at 3-month intervals as follows: step 2, acebutolol 200 mg or carvedilol 25 mg plus hydrochlorothiazide 12.5 mg once daily; step 3, acebutolol 400 mg or carvedilol 50 mg plus hydrochlorothiazide 25 mg once daily. Overall, significant but modest BP reduction was achieved with both β blockers at 3 months. In the acebutolol group, 24-hour BP decreased from 142 ± 15/94 ± 7 mm Hg to 138 ± 16/89 ± 8 mm Hg (p <0.005 for diastolic BP at 3 months vs baseline). Mean day BP decreased from 145 ± 15/98 ± 5 mm Hg to 140 ± 14/93 ± 7 mm Hg (p <0.05 for systolic BP and p <0.0005 for diastolic BP at 3 months vs baseline). In the carvedilol group, 24-hour BP decreased from 145 ± 11/93 ± 6 to 138 ± 16/87 ± 9 mm Hg (p <0.05 for systolic BP and p<0.005 for diastolic BP at 3 months vs baseline). Mean day BP decreased from 149 ± 10/99 ± 5 to 141 ± 16/91 ± 87 mm Hg (p <0.05 for systolic BP and p<0.0005 for diastolic BP at 3 months vs baseline). At 12 months, most patients required combination therapy to achieve BP control. The control (mean day diastolic BP <90 mm Hg) and response (mean day diastolic BP decrease ≥10 mm Hg) rates at 12 months were 59% and 82% in the acebutolol and 78% and 78% in the carvedilol groups, respectively. In conclusion, acebutolol or carvedilol in combination with hydrochlorothiazide, rather than acebutolol or carvedilol alone, should be considered as first-line antihypertensive therapy in black patients with mild to moderate hypertension.