Combined Diuretic and Sympatholytic Therapy in Elderly Patients with Predominant Systolic Hypertension

¹ From the Section of Clinical Pharmacology and Hypertension, Veterans Administration Medical Center, Long Beach, California, and the University of California, Irvine

It has been speculated that the convenience and palatability of low-dose combination antihypertension treatment might enhance therapeutic effectiveness and compliance, especially in elderly patients. To test this possibility, patients over 60 years of age with predominant systolic hypertension were treated with a combination of a diuretic, chlorthalidone, and the centrally acting inhibitor of sympathetic activity, clonidine. The results of active treatment in these patients (n = 13) were compared with those of a placebo (n = 11). Active therapy with low doses of chlorthalidone and clonidine (usually once daily) controlled blood pressure (systolic pressure <140 mm Hg) in 12 of the 13 patients without inducing orthostatic hypotension. Administration of placebo did not result in significant changes in blood pressure. The diuretic-clonidine combination induced only small decreases in serum potassium levels and small increases in uric acid; no significant changes in creatinine clearance were observed. Both active and placebo therapy were tolerated without significant side effects. This study reveals that combined therapy with low doses of chlorthalidone and clonidine is effective, convenient, and palatable in controlling blood pressure in elderly patients with predominant systolic hypertension and supports the idea that treatment with sympathoinhibitory and volume-depleting agents is appropriate for this form of hypertension.