The goals of this competing continuation are (1) to complete the one-year follow-up of the study of the effects on blood pressure, cognition, and quality of life (affect, anxiety, sexual function and interest) of a lipophilic beta blocker compared to a non- pharmacological intervention (the Current Study) and (2) to complete a study of the effects on cognition, and quality of life of a lipophobic beta blocker in comparison to a lipophilic beta blocker and placebo (the New Study). The current study is comparing propranolol (vs placebo) and a non-pharmacological intervention (vs no intervention) in a 2 X 2 design. Assessments at baseline and 3 and 12 months include blood pressure (clinic and ambulatory), cognition, depression, anxiety, sexual interest and function, Type A, anger, and other side effects. A total of 300 subjects will be randomized by January 1988, with the one-year follow-up completed in January 1989. 3-month data indicate main effects of propranolol on blood pressure, side effects, and some cognitive functions. The non-pharmacologic intervention has shown a main effect on urinary sodium and trends for exercise. There is a significant interaction effect of drug and non- pharmacologic intervention on blood pressure. Because the liposolubility of beta blockers is a key determinant in the distribution of the drug throughout the body, the Follow-up Study will compare, in a randomized double-blind protocol, a lipophilic beta blocker (propranolol) with a lipophobic beta blocker (atenolol) and a placebo over a 3 month period. A total of 50 subjects will be randomized to each arm, with assessments at baseline, 2 weeks, and 3 months. Recruitment and randomization will begin in June 1988 (pending approval of this application) and be completed in June 1989.
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