Ketanserin, an Effective Third-Line Agent in Primary Hypertension
Thiazide diuretics and t/-adrenoceptor antagonists remain the cornerstone of therapy in the stepped care approach to the treatment of hypertension (Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure 1984). There is less consensus, however, as to the most appropriate third-line agent when this combination fails to control the blood pressure (McAreavey et al. 1984; Maclean et al. 1986; Ramsay et al. 1987). Thus, other agents need to be evaluated for this potential role. Ketanserin is a serotonin S2-receptor antagonist which also has weak a-adrenoceptor-blocking properties (Van Nueten et al. 1981). This combination of vasodilator properties makes ketanserin a potentially useful antihypertensive agent, whether used alone (Woittiez et al. 1986) or in conjunction with either thiazides or t/-blockers (Beretta-Piccoli et al. 1987). Ketanserin is also said to have a 'favourable' effect on serum lipoproteins. to reduce platelet activity, and to reduce the incidence of cardiovascular events in high risk patients (Hansson & Hedner 1987). Despite these properties, ketanserin has yet to find a role in the treatment of hypertension. The present study was designed to assess the value of ketanserin as a third-line agent in patients whose blood pressure was not adequately controlled by treatment with a fixed combination of ate nolo I and chlorthalidone.