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 .
Effects of combined ACE inhibitor and angiotensin II antagonist treatment in human chronic nephropathies.
BACKGROUND Proteinuria predicts renal disease progression , and its reduction by angiotensin-converting enzyme inhibitors ( ACEi ) or angiotensin II receptor antagonists ( ARA ) is renoprotective . METHODS In this prospect i ve , r and omized , cross-over study of 24 patients with nondiabetic , chronic nephropathies , we compared the effects on proteinuria , renal hemodynamics , and glomerular permselectivity of 8 weeks with comparable blood pressure control achieved by benazepril ( 10 mg/day ) and valsartan ( 80 mg/day ) combined therapy with those achieved by benazepril ( 20 mg/day ) or valsartan ( 160 mg/day ) alone . RESULTS Despite comparable changes in blood pressure and glomerular filtration rate ( GFR ) , combined therapy decreased proteinuria more than benazepril ( -56 % vs. -45.9 % , P=0.02 ) and valsartan ( -41.5 % , P=0.002 ) . Changes in urinary protein to creatinine ratio followed the same trend . Filtration fraction and renal vascular resistances ( RVR ) decreased more with combined ( -14.7%,-23.7 % ) or benazepril ( -12.4 % , -20.5 % ) than with valsartan ( -2.7 % , -12.5 % , P < 0.05 vs. both ) . RVR changes , adjusted for GFR changes , were associated with those in proteinuria ( P < 0.05 ) . Changes in glomerular permeability were comparable and did not predict different changes in proteinuria in the three groups . CONCLUSION At comparable blood pressure , combined ACEi and ARA decreased proteinuria better than ACEi and ARA . The greater antiproteinuric effect most likely depended on an ACEi-related hemodynamic effect , in addition to glomerular size selectivity amelioration . Long-term combined ACEi and ARA therapy may be more renoprotective than treatment with each agent alone
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 .