Comparison of guanfacine versus clonidine for efficacy, safety and occurrence of withdrawal syndrome in step-2 treatment of mild to moderate essential hypertension
Abstract
Guanfacine, an alpha 2-adrenoceptor agonist, was compared with clonidine as step-2 therapy of mild to moderate essential hypertension in a 24-week, double-blind, randomized, parallel evaluation to determine efficacy, safety and occurrence of withdrawal syndrome. During a 5-week period, patients were weaned from current antihypertensives, if any, and stabilized on step-1 therapy with 25 mg of chlorthalidone once a day. Those with a diastolic blood pressure (BP) from 95 to 114 mm Hg while taking chlorthalidone were randomized to treatment. The 2 agents had equal efficacy; 149 of 270 patients treated with guanfacine (55%) and 164 of 276 treated with clonidine (59%) achieved goal diastolic BP of less than or equal to 90 mm Hg. Terminations because of adverse effects were relatively low. Dry mouth (30% of guanfacine and 37% of clonidine groups) and somnolence (21% of guanfacine and 35% of clonidine groups, p less than 0.05) were reported most frequently. Nonsyncopal dizziness was reported in 11% of guanfacine-treated and 8% of clonidine-treated patients. This difference was not statistically significant. To evaluate the occurrence of a withdrawal syndrome in 316 outpatients and 156 inpatients, vital signs were monitored at least twice a day for up to 7 days after the end of therapy. Segmented 24-hour urine studies were performed on inpatients. Abrupt withdrawal of clonidine produced a rapid increase in diastolic and, especially, systolic BP, whereas guanfacine withdrawal produced…
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Guanfacine has fewer CNS adverse effects than clonidine, such as sedation, headache, orthostatic hypotension and impotence, and a lower incidence of withdrawal symptoms such as high BP, headache, tremor, restlessness, and nausea (3% vs. 50-80% with clonidine).
“Also, guanfacine has fewer CNS adverse effects than clonidine, such as sedation, headache, orthostatic hypotension and impotence,42,43 and a lower incidence of withdrawal symptoms such as high BP, headache, tremor, restlessness, and nausea (3% vs. 50–80% with clonidine).42,44–47”
From Hyperadrenergic Postural Tachycardia Syndrome: Clinical Biomarkers and Response to Guanfacine (2024) · cites this paper as [45]
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References 12 · Cited by 29
- Authors
- Wilson, M. F., Haring, O., Lewin, A., Bedsole, G., Stepansky, W., Fillingim, J., Hall, D., Roginsky, M., McMahon, F. G., Jagger, P., & Strauss, M.
- Corresponding author
- Wilson, Michael F.
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 1986-03
- Volume
- 57
- Issue
- 9
- Pages
- E43-E49
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2113759011
- Cited by
- 29
- References
- 12
- Citations by year
- 2024: 1 · 2021: 1 · 2020: 1 · 2014: 3 · 2013: 1 · 2012: 1
- FWCI
- 2.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- guanfacine, clonidine, essential hypertension, alpha-2 adrenergic agonists, drug withdrawal syndrome, chlorthalidone, blood pressure control, adverse effects, xerostomia, sleepiness
- MeSH terms
- Adult, Blood Pressure, Clinical Trials as Topic, Clonidine, Double-Blind Method, Drug Evaluation, Female, Guanidines, Humans, Hypertension, Male, Middle Aged, Phenylacetates, Random Allocation, Substance Withdrawal Syndrome, Guanfacine
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