Reserpine-diuretic combination in the treatment of hypertension. A review

Background: Fixed combinations of reserpine and a diuretic are not generally accepted as initial therapy of arterial hypertension. Reserpine has been discouraged because of severe adverse events such as depression and peptic ulcer. Clinical Pharmacology: Reserpine leads to depletion of catecholamine stores in central and peripheral neurons and thus reduces sympathicotonus. Given as monotherapy reserpine has only weak antihypertensive properties. In combination with a diuretic even low doses of the drug (0.05 to 0.125 mg daily) lower blood pressure sufficiently. Side Effects: Nasal constipation is the most frequently reported adverse event. Depression and peptic ulcer do not occur under low-dose reserpine-diuretic combinations. Vascular Morbidity and Mortality: Several epidemiologic trials demonstrate that cardiovascular as well as cerebrovascular morbidity and mortality can be reduced by reserpine-diuretic combinations. Costs: Reserpine-diuretic combinations cost less than calcium antagonists, ACE-inhibitors and angiotensin-II-receptor antagonists. Conclusion: Low-dose reserpine-diuretic combinations can be used as first line treatment in patients with mild to moderate arterial hypertension.