Effects of antihypertensive drugs on SBP variability are dose-dependent and persist when used in combinations .
Use of a high dose of a calcium channel blocker alone or in combination with other agents is therefore likely to be particularly effective in prevention of stroke
BACKGROUND AND PURPOSE Recent studies have shown that visit-to-visit blood pressure variability is a powerful risk factor for stroke , is reduced by calcium channel blockers and diuretics , and increased by β-blockers .
However , it is unknown whether these effects are dose-dependent and persist in combination with other drugs .
Contrasting effects of enalapril and metoprolol on proteinuria in diabetic nephropathy.
OBJECTIVE --To assess whether angiotensin converting enzyme inhibition reduces proteinuria in diabetic nephropathy more than blood pressure reduction with other antihypertensive treatment . DESIGN -- Prospect i ve , open r and omised study lasting eight weeks in patients with diabetic nephropathy . SETTING --Outpatient nephrology clinics . PATIENTS --40 Patients with type I diabetes and diabetic nephropathy with reduced renal function . INTERVENTION -- Antihypertensive treatment with enalapril or metoprolol , usually combined with frusemide . MAIN OUTCOME MEASURES --Arterial blood pressure and urinary excretion of albumin and protein . RESULTS --Arterial blood pressure after eight weeks was 135/82 ( SD 13/7 ) mm Hg in the group given enalapril and 136/86 ( 16/12 ) mm Hg in the group given metoprolol .  Proteinuria and albuminuria were similar in both groups before r and omisation . After eight weeks ' treatment , the geometric mean albumin excretion was 0.7 ( 95 % confidence interval 0.5 to 1.2 ) g/24 h in the patients given enalapril and 1.6 ( 1.1 to 2.5 ) g/24 h in the patients given metoprolol ( p less than 0.02 ) . The proteinuria was 1.1 ( 0.7 to 1.7 ) and 2.4 ( 1.6 to 3.6 ) g/24 h respectively ( p less than 0.02 ) . CONCLUSIONS --Antihypertensive treatment with enalapril reduced proteinuria in patients with diabetic nephropathy more than an equally effective antihypertensive treatment with metoprolol . This points to a specific antiproteinuric effect of the angiotensin converting enzyme inhibitor independent of the effect on systemic blood pressure
Effects of antihypertensive drugs on SBP variability are dose-dependent and persist when used in combinations .
Use of a high dose of a calcium channel blocker alone or in combination with other agents is therefore likely to be particularly effective in prevention of stroke
BACKGROUND AND PURPOSE Recent studies have shown that visit-to-visit blood pressure variability is a powerful risk factor for stroke , is reduced by calcium channel blockers and diuretics , and increased by β-blockers .
However , it is unknown whether these effects are dose-dependent and persist in combination with other drugs .