title: Reserpine plus hydrochlorothiazide and sotalol plus hydrochlorothiazide in Black and Indian hypertensive patients. [Combined uni- and multicenter double-blind studies in hypertensive patients. Comparison of blood pressure measurements]. Diltiazem for treatment of essential hypertension: a double-blind controlled study with reserpine. Different concepts in first-line treatment of essential hypertension. Comparison of a low-dose reserpine-thiazide combination with nitrendipine monotherapy. German Reserpine in Hypertension Study Group. Propranolol in the treatment of essential hypertension. Anti-hypertensive adrenergic-blocking agents: effects on sodium balance, the renin-angiotensin system and haemodynamics.
abstract: Fifty patients ( 25 Blacks and 25 Indians ) suffering from mild-to-moderate hypertension ( supine diastolic blood pressure 100 - 105 mmHg ) were studied in order to compare the antihypertensive effect of a combination of a beta-blocker ( sotalol hydrochloride 160 mg/d ) plus a thiazide derivative ( hydrochlorothiazide 25 mg/d ) ( Sotazide ; B-M ) with that of a combination of reserpine 0,1 mg/d ( Serpasil ; Ciba ) plus hydrochlorothiazide 25 mg/d ( Dichlotride ; Frosst MSD ) . The combination of reserpine plus hydrochlorothiazide was found to be as effective as that of sotalol plus hydrochlorothiazide in lowering the blood pressure in both the Black and the Indian patients . Two patients taking the combination containing reserpine developed side-effects , but this did not occur in any of those taking the combination containing sotalol . We feel that in developing countries , where the cost of therapy is important , reserpine in a dosage of less than 0,1 mg/d plus a thiazide derivative in low dosage is preferable to a beta-blocker plus a thiazide derivative in the treatment of hypertension In a double-blind study to investigate the antihypertensive effect of a fixed triple combination with 0.05 mg reserpine , 2.5 mg clopamide and 0.4 mg dihydroergocristine in comparison to a fixed double combination with 0.05 mg reserpine and 2.5 mg clopamide , a patient subgroup of 34 patients followed a unicenter ( central unit , ' institute ' ) as well as a multicenter ( established physicians ) study design . The patients visited both investigation units on the day of admission to the study ( week 0 ) , after four weeks and after eight weeks of therapy ( after the morning intake of the drugs ) . The paper in h and looks at the results of this subgroup with respect to the conformity of blood pressure values in the two investigative units . The analyses confirm the already published results of the entire study : Both combinations proved to be highly effective antihypertensive drugs . The triple combination showed therapeutical advantages for systolic blood pressure after four weeks , for diastolic pressure after eight weeks of therapy at the ' institute ' as well as , although less distinct , in the medical offices . A comparison of the individual values did not show a convincing coherence of the measurements between institute and offices . All investigated possible systematic sources of error ( different methods of measurement , days or times of measurement ) could be excluded by correlation statistics as a reason for the divergences . The results show the necessity -- particularly in multicenter studies --of a careful documentation of all accompanying data ( e.g. method or time of measurement ) as well as a greatest possible st and ardization of investigation ( e.g. identical measuring apparatus and investigator . In a double-blind , parallel , 12-week trial , antihypertensive effects of diltiazem and reserpine were compared in 107 patients with essential hypertension .  Diltiazem reduced blood pressure from 176/100 mmHg to 154/86 mmHg after 12 weeks , and reserpine reduced blood pressure from 171/96 mmHg to 155/85 mmHg . The difference between diltiazem and reserpine was not statistically significant . However , among a subset of patients given 180 mg/day of diltiazem , a significantly better antihypertensive effect was achieved than among a subset given 0.3 mg of reserpine . The incidence of side effects and complications in the diltiazem group was about one half that in the reserpine group ( 12.3 % and 27.1 % , respectively ) . Side effects of diltiazem were mild , and the drug was extremely well tolerated . These results show that diltiazem is an effective antihypertensive drug for the treatment of mild to moderate essential hypertension Low-dose combination therapy has been proposed as a rational first-line approach to hypertension treatment . We compared the efficacy and tolerability of the fixed combination of reserpine ( 0.1 mg ) plus the thiazide clopamid ( 5 mg ) with its single components and the calcium-antagonist nitrendipine ( 20 mg ) in a r and omized , double-blind , parallel study of 273 hypertensive patients with diastolic blood pressure ( BP ) between 100 and 114 mm Hg . The four groups did not differ regarding baseline characteristics ( mean age , 58 years ; 51 % men ; mean BP after a 2-week placebo period , 158 to 160/103 to 104 mm Hg ) . After 6 weeks of treatment with one capsule daily , mean reductions in sitting BP from baseline at 24 hours after dosing in the reserpine-clopamid combination , reserpine , clopamid , and nitrendipine groups were -23.0/-17.1 , -14.0/-11.7 , -13.6/-11.9 , and -11.6/-12.3 mm Hg , respectively ( 2P < .01 ) . The corresponding normalization rates ( diastolic BP < 90 mm Hg ) were 55 % , 40 % , 36 % , and 33 % ( 2P = .11 ) . All patients whose BP had not been normalized at this point received two capsules of the respective medication once daily from weeks 7 to 12 . At week 12 , mean BP reductions were -25.7/-18.1 , -14.6/-12.2 , -17.7/-13.4 , and -14.9/-15.3 mm Hg in the four groups , respectively ( 2P < .01 ) . The respective normalization rates were 69 % , 35 % , 39 % , and 45 % ( 2P < .0001 ) . Linear regression modeling indicated that reserpine and clopamid combined acted more than additively . As regards tolerability , adverse experiences were observed in 27 % , 28 % , 29 % , and 48 % of patients , respectively ( 2P < .05 ) . The respective rates of premature discontinuation because of adverse effects were 3 % , 3 % , 7 % , and 13 % ( 2P = .06 ) . In conclusion , a low-dose combination of reserpine and clopamid lowered BP significantly more than both the components alone and nitrendipine . Moreover , the combination was tolerated as well as its components and significantly better than nitrendipine . Thus , the use of this low-dose reserpine-thiazide combination appears to be a rational alternative to conventional monotherapy in the first-line treatment of hypertension In a series of 450 patients with mild essential hypertension , propranolol alone ( P ) , propranolol plus hydrochlorothiazide ( P+T ) , propranolol plus hydralazine ( P+H ) , and propranolol plus hydrochlorothiazide plus hydralazine ( P+T+H ) were compared to reserpine plus hydrochlorothiazide ( R+T ) . Comparison was based on reduction of diastolic blood pressures ( BP ) to below 90 mm Hg and at least 5 mm Hg less than initial BP after six months of treatment . This was achieved in 92 % of patients who received P+T+H , 88 % taking R+T , 81 % receiving P+T , 72 % on P+H and 52 % taking P alone . The number of drop-outs , morbid events , and terminating side effects were insignificantly different among the various regimens . In this study , P and P+H were less effective , while P+T and P+T+H were as effective as the st and ard regimen 1 . The changes in plasma volume , haemodynamic variables , plasma renin activity and plasma aldosterone were studied in forty-one hypertensive patients after administration of adrenergic-blocking agents .  Four drugs were used : alpha-methyldopa ( fourteen patients ) , guanethidine ( ten patients ) , clonidine ( nine patients ) and reserpine ( eight patients ) . Drugs were administered orally during 7 days ' hospitalization on a normal sodium diet ( 110 mmol/day ) . 2 . The four drugs had similar effects : a significant decrease in blood pressure , a significant increase in plasma volume and no change in stroke volume . 3 . With alpha-methyldopa and guanethidine , heart rate , plasma renin activity and plasma aldosterone were unchanged . 4 . With reserpine and clonidine , heart rate and plasma renin activity were significantly decreased , whereas plasma aldosterone did not change significantly . 5 . This study suggests that the decrease in plasma renin activity was related to the lowering of the heart rate rather than to sodium retention and that adrenergic-blocking agents can impair the normal relationship between stroke index and plasma volume , between plasma volume and plasma renin activity , and between plasma renin activity and plasma aldosterone
target: Due to significant heterogeneity across trials , a significant effect in diastolic blood pressure ( DBP ) , mean arterial pressure ( MAP ) , and heart rate ( HR ) could not be found .
  The SBP effects were achieved with 0.5 mg/day or greater .
  AUTHORS ' CONCLUSIONS Reserpine is effective in reducing SBP roughly to the same degree as other first-line antihypertensive drugs .
background: BACKGROUND Many antihypertensive agents exist today for the treatment of primary hypertension ( systolic blood pressure > /=140 mmHg and /or diastolic blood pressure > /=90 mmHg ) .
  R and omised controlled trials have been carried out to investigate the evidence for these agents .
  There is , for example , strong RCT evidence that thiazides reduce mortality and morbidity .
  Reserpine has been used as a second-line therapy in some of those trials .
  However , the dose-related blood pressure reduction with this agent is not known .
  OBJECTIVES To investigate the dose-related effect of reserpine on blood pressure , heart rate and withdrawals due to adverse events .