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 .
Combination of amlodipine and enalapril in hypertensive patients with coronary disease.
BACKGROUND Patients ( pts ) with stable coronary artery disease ( CAD ) can benefit from a decrease in the blood pressure ( BP ) , according to recent studies . OBJECTIVE To evaluate the efficacy and tolerability of the fixed combination : amlodipine + enalapril , when compared to amlodipine in the normalization of the diastolic arterial pressure ( DAP ) ( < 85 mmHg ) , in pts with CAD and systemic arterial hypertension ( SAH ) . METHODS Double-blind and r and omized study , with two groups of pts with DAP > or = 90 and < 110 mmHg and CAD . Patients with left ventricular ejection fraction ( LVEF ) < 40 % , symptoms of heart failure or angina class III and IV , severe diseases and DAP > or = 110 mmHg during the four-week wash-out with atenolol treatment alone , were excluded . After the wash-out , pts were r and omly distributed for the use of the combination ( A ) or amlodipine ( B ) and were followed every four weeks up to 98 days . The initial doses ( in mg ) were , respectively : A- 2.5/10 and B- 2.5 ; the doses were increased when DAP > 85mmHg , at the visits . Statistical analysis was carried out with chi2 , Fischer and analysis of variance , for p < 0.05 . RESULTS Of the 110 selected pts , 72 ( A= 32 , B= 40 ) were r and omized . The decreases in DAP and systolic arterial pressure ( SAP ) were significant ( p < 0.01 ) , but with no difference between the groups in mmHg : SAP , A ( 127.7 + /- 13.4 ) and B ( 125.3 + /- 12.6 ) ( p= 0.45 ) and DAP , A ( 74.5 + /- 6.7 mmHg ) and B ( 75.5 + /- 6.7 mmHg ) ( p= 0.32 ) . Group A presented a lower incidence of lower-limb edema : ( 7.1 % vs 30.6 % , p=0.02 ) on the 98th day of follow-up . CONCLUSION The fixed combination of enalapril and amlodipine , as well as isolated amlodipine , was effective in the normalization of BP in pts with CAD and SAH stages I and II , adding blockage of the renin-angiotensin system
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 .