Double-blind comparison of the cardioselective beta-blockers bisoprolol and atenolol in hypertension: the Bisoprolol International Multicenter Study (BIMS)

The antihypertensive efficacy and tolerability of bisoprolol and atenolol were compared in the Bisoprolol International Multicenter Study (BIMS). In 104 patients with essential hypertension (21 to 70 years of age and diastolic blood pressures (DBP) of 100-120 mm Hg in the sitting position), after a four-week placebo period, the active drug was given in a random double-blind crossover design (10 to 20 mg bisoprolol, 50 to 100 mg atenolol) for eight weeks each, with a 2 to 6 week placebo wash-out phase between active therapy. All blood pressures were recorded 24 h after drug intake. Of the 104 patients, 10 were withdrawn during the study because of unwanted effects, unsatisfactory blood pressure response, or intercurrent disease, leaving 94 for intraindividual comparisons. After 8 weeks active treatment with individually titrated dose, there were slightly, but significantly greater falls in blood pressure with bisoprolol (p less than or equal to 0.05). Diastolic target pressures of less than or equal to 95 mm Hg were reached in 68% with bisoprolol and 56% with atenolol (p less than or equal to 0.05; Mc Nemar). There was no between treatment group difference in the patients' self-assessed well-being. For both drugs, response rates were greater in patients below the age of 60 years than in those above 60 years. Better antihypertensive responses were observed with bisoprolol in patients regularly smoking cigarettes

TRENDS IN CORONARY RISK-FACTORS IN ITALY

Three large-scale epidemiological surveys covering some major coronary risk factors were conducted in Italy in population samples of men and women aged 30-59 years. The first survey was carried out in 1978-1979 (RF2 study; nine samples in eight regions; 2561 men and 2912 women); the second in 1983-1984 (OB43 study; nine samples in the same eight regions; 2267 men and 2398 women); and the third one in 1985-1987 (MICOL study; 18 samples in 10 regions; 14411 men and 12611 women). Time trends in mean age standardized risk factors levels showed slight but systematic decreases in blood pressure, cigarette smoking (only in men), and body mass index (only in women); whereas no substantial changes were observed in serum cholesterol levels. The combined multiple coronary risk estimated by a model produced in a previous study, showed a decline between 1978-1979 and 1983-1984 of 5.5% in men and 13.4% in women. These changes were compared with the official coronary death rates between 1984 and 1987 in the whole country and in the regions where the samples were located. The expected/observed ratio computed in different ways ranged from 0.54 to 0.88 for men and was over 1 for women. Changes in the levels of major risk factors and changes in coronary mortality seem biologically coherent at least in men