dc.contributor.author | Yonga, Gerald O | |
dc.date.accessioned | 2013-05-23T09:23:49Z | |
dc.date.available | 2013-05-23T09:23:49Z | |
dc.date.issued | 1990 | |
dc.identifier.citation | Master of Medicine (internal medicine) | en |
dc.identifier.uri | http://erepository.uonbi.ac.ke:8080/xmlui/handle/11295/24762 | |
dc.description | A dissertation submitted in part-fulfilment for the Degree of Master of Medicine (internal
medicine) of the University of Nairobi. | en |
dc.description.abstract | A prospective study to compare propranolol monotherapy and hydroflumenthiazide
monotherapy in adult African patients with essential mild to moderate hypertension was
carried out at Kenyatta National Hospital. 60 men and women aged between 22 and 65
years and with blood pressures ranging from 130/100mmHg to 180/110mmHg were enrolled.
Patients with obstructive airway disease, heart failure, diabetes mellitus, hepatic disease
and renal disease were excluded. They all underwent history taking, physical
examination, baseline serum potassium, uric acid, fasting glucose and lipid profiles, and
electrocardiogram (ECG). They were then randomnly assigned to either of the two
treatment regimmens and followed-up 4-weekly for 12 weeks with serial monitor of
symptoms, blood pressure, pulse and repeat ECG and serum bicohemsitry at end of week -12.
Bias in blood pressure recordings was removed by the use of a randornn-osphygmomanometer
and laboratory analysis of specimens was blinded.
Hydroflumethiazide was significantly more effective in lowering diastolic blood pressure
than propranolol (p < 0.01). Neither of the two drugs produced any ECG - left ventricular
hypertrophy regression. Hydroflumethiazide was more associated with palpitations,
sweating and impotence while propranolol was more associated with exertionaI dyspnoea
and Raynaud's phenomenon. Hydroflumethiazide treatment was also associated with
significant increases in total serum cholesterol, low-density-lipoproteins (LDL) cholesterol,
serum uric acid levels and fasting serum glucose levels (p < 0.001); and significant fall in
potassium levels (p < 0.01). In the propranolol treated patients, very low-density
lipoproteins (VLDL) and total serum triglycerides rose significantly and HDL-cholesterol
levels also declined significantly (p < 0.01).
Propranolol had no significant effect on all the cardiovascular risk factors studied.
Hydroflumethiazide significantly reduced the number of patients with hypertension (BP >
140/90 mmHg) but also significantly increased the number of patients with
hyperuricaemia. The cost of propranolol treatment was three times that of
hydroflumethiazide treatment.
The use of beta-blocker monotherapy in black Kenyan patients with mild to moderate
hypertension is not recommended. Thiazide monotherapy is effective and cheap but its
metabolic side-effects need further studies to determine their significance in the Kenyan
set-up. | en |
dc.language.iso | en | en |
dc.publisher | University of Nairobi | en |
dc.title | A comparative study on efficacy, tolerability, and some metabolic side-effects of propranolol and hydroflumethiazide in adult African patients with mild to moderate hypertension | en |
dc.type | Thesis | en |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
local.publisher | College of Health Sciences | en |