Three studies highlight hypertension treatments: a hormone therapy, a reformulated [beta]-blocker, and the benefits of lowering BP and lipids are reviewed.(Clinical Rounds)

ATLANTA -- A new hormone therapy for postmenopausal symptoms also has a significant antihypertensive effect; the popular [beta]-blocker carvedilol comes in a once-daily formulation; and an analysis of more than 600 patients with hypertension quantified the potential for reducing coronary heart disease by controlling blood pressure and serum lipids. These three poster reports were among the hypertension studies presented at the annual meeting of the American College of Cardiology.

New Progestin Lowers Blood Pressure

Drospirenone is a new progestin with antialdosterone effects that is being developed for use with 17-[beta] estradiol to treat postmenopausal symptoms. The effect of drospirenone and estradiol on blood pressure was assessed in a dose-ranging study with 750 women. All participants were postmenopausal women with mild to moderate hypertension, with a systolic pressure of 140-179 mm Hg and a diastolic pressure of 90-109 mm Hg when off treatment.

The women were randomized to treatment with estradiol alone; estradiol plus 1 mg, 2 mg, or 3 mg of drospirenone daily; or placebo. After 8 weeks of treatment, average clinical blood pressure readings in the placebo group had fallen by 8.7 mm Hg (systolic) and by 5.0 mm Hg (diastolic), compared with baseline readings. Estradiol treatment alone produced no significant reduction in blood pressure when compared with the placebo effect.

Women treated with 1 mg of drospirenone daily had an average additional systolic blood pressure reduction of 0.9 mm Hg and an additional diastolic pressure reduction of 2.0 mm Hg, compared with the placebo group; this was of borderline statistical significance. The higher dosages of drospirenone had a more marked effect. Women taking a 2-mg daily dosage had an average additional fall in systolic pressure of 3.4 mm Hg and in diastolic pressure of 4.0 mm Hg, compared with the placebo group, which were statistically significant declines, reported Dr. William B. White, chief of the section of hypertension and clinical pharmacology at the University of Connecticut, Farmington, and his associate. Similar drops in pressure were also seen in women who received 3 mg of drospirenone daily.

All three dosages of drospirenone were "well tolerated, with modest subjective or objective adverse events," said Dr. White and his associate in their poster. The percentage of patients who developed hyperkalemia while on treatment was similar in all five treatment groups. Other details of adverse effects were not reported. Further studies are needed to examine the effect of treatment for 2 or more years, he said. The study was sponsored by Berlex, which is developing drospirenone.

Once-Daily Carvedilol Assessed