Pindolol once daily in the treatment of hypertension

Antihypertensive treatment with pindolol in one or two doses. A comparative trial

A comparative trial was carried out in 21 patients on the antihypertensive effect of pindolol given once or twice a day. A change-over design was employed, with two treatment schedules and four treamtnet periods of six weeks each. No statistically significant difference was found in BP lowering effect between one and two daily doses. It is unlikely that a switch from pindolol twice daily to the same amount once daily will crease the BP by more than at most 1.0 mmHg systolic and 2.2 mmHg diastolic, or decrease it by more than 2.7 and 1.0 mmHg, respectively. It is concluded that pindolol given once daily can be recommended.

The influence of pindolol and hydrochlorothiazide on blood pressure, and plasma renin and plasma lipid levels

After three weeks' administration of placebo, three groups of eight patients with moderate hypertension were randomly assigned to single daily dose, double-blind treatment with either pindolol 15 mg, hydrochlorothiazide 50 mg, or a combination of both for eight weeks. All determinations were made 24 hours after ingestion of a dose. Reductions in supine, sitting, and standing systolic and diastolic blood pressure were greater in patients receiving hydrochlorothiazide than in those administered pindolol; however, the greatest reductions were registered in individuals receiving combination therapy. Mean basal plasma renin activity rose significantly from 0.45 +/- 0.44 to 1.42 +/- 1.31 ng/mL/hr and from 0.67 +/- 0.46 to 1.27 +/- 0.83 ng/mL/hr in patients receiving hydrochlorothiazide and combination therapy, respectively, but there was no change in those administered pindolol. Hydrochlorothiazide and combination therapy increased mean total cholesterol levels from 247 +/- 25 to 263 +/- 37 mg/dL and 198 +/- 36 to 211 +/- 33 mg/dL, respectively, at eight weeks, and both increased mean triglyceride concentrations at two weeks. Pindolol did not show any tendency to alter lipid levels. Pindolol should be given twice daily. At 15 mg daily, it has little or no effect on basal plasma renin activity or plasma lipid levels.

Ambulatory blood pressure during once-daily randomised double-blind administration of atenolol, metoprolol, pindolol, and slow-release propranolol

Intra-arterial ambulatory blood pressure was measured over 24 hours, in 34 patients with newly diagnosed hypertension, both before and after double-blind randomisation to treatment with atenolol (n=9), metoprolol (n=9), pindolol (n=9), or propranolol in its slow-release form (n=7). The dosage of each drug was adjusted at monthly clinic visits until satisfactory control of blood pressure was achieved (140/90 mm Hg or less by cuff) or the maximum dose in the study protocol was reached. A second intra-arterial recording was made after these drugs had been taken once daily at 0800 for three to eight months (mean 5.0+/-SD 1.4) and was started four hours after the last dose.At the end of the 24-hour recordings blood pressure was significantly lower with all four drugs. The extent to which the drugs reduced blood pressure, however, differed over the 24 hours. Atenolol lowered mean arterial pressure significantly throughout all 24 recorded hours, metoprolol for 12 hours, pindolol for 15 hours, and slow-release propranolol for 22 hours. Neither metoprolol nor pindolol lowered blood pressure during sleep. A significant reduction in heart rate was observed over 20 hours with atenolol, 20 hours with metoprolol, 10 hours with pindolol, and 24 hours with slow-release propranolol. Atenolol, metoprolol, and slow-release propranolol continued to slow the heart rate 24 hours after the last tablet was taken; this effect on heart rate, however, was not sustained throughout the second morning in those patients taking atenolol. Pindolol, the only drug studied that has intrinsic sympathomimetic activity, increased heart rate and did not lower blood pressure during sleep.Atenolol and slow-release propranolol are effective as antihypertensive agents over 24 hours when taken once daily, whereas metoprolol and pindolol may need to be taken more frequently. At times of low sympathetic tone, however, such as during sleep, beta-blockers with intrinsic sympathomimetic activity may raise heart rate and attenuate the fall in blood pressure with treatment.

Once daily beta-blocker in hypertension--oxprenolol slow-release

In a within-patient comparison of conventional oxprenolol administered twice daily with slow-release oxprenolol administered once daily in the treatment of hypertension, twenty patients previously responsive to beta-blockers took each formulation for 4 weeks, after wash-out periods off beta-blocker of 2 weeks' duration. The order of administration of the two forms was randomized, and sixteen patients continued medication with cyclopenthiazide 0.5 mg daily. Blood pressure levels at the end of the 4-week treatment periods were compared with levels at the end of the preceding 2-week wash-out periods. Both formulations lowered blood pressure and pulse rate significantly. There was no difference in their effects on pulse rate or on blood pressure, whether measured by the doctors using standard sphygmomanometers or by the hypertension sister using a random-zero sphygmomanometer. In four patients who measured their own blood pressures at home each morning (before medications), afternoon and night, mean levels were similar with the two formulations. Both formulations were very well tolerated.

Controlled study of the bronchoconstriction effect of pindolol administered intravenously or orally to patients with unstable asthma

Pindolol, a beta-blocking drug, was given intravenously (0.2 mg) to 4 patients and orally (15 mg) to 4 patients, all in remission after acute exacerbation of asthma. In all cases it induced chest tightness and marked decrease in specific airway conductance, FEV1 and FVC and maximum expiratory flow at low lung volumes. The increase in airway obstruction after pindolol was not reversed by inhalation of a beta-sympathomimetic aerosol. The results suggest that conventional doses of pindolol may cause significant worsening of asthma in patients with unstable disease.

Once daily administration of pindolol in the treatment of hypertension

An open study was carried out in general practice on patients with mild to moderate essential hypertension to assess the effectiveness of treatment with pindolol on a single daily dose regimen. In twenty-two previously untreated cases given a single daily dosage of pindolol (mean 13-0 mg, range 5 mg- 30 mg), adequate blood pressure control was achieved within five weeks and maintained in the nineteen patients examined at Week 25. Of eleven previously treated patients whose blood pressure was adequately controlled by divided daily doses of pindolol, a change-over to a single daily dosage of pindolol (mean 13-2 mg, range 10 mg-20 mg) did not result in any loss of control over a twenty-five week study period. Few side-effects were reported, and only one patient was withdrawn from the study.