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 .
Comparisons of Once‐Daily Nilvadipine with Enalapril and Diuretic in Patients with Essential Hypertension
The antihypertensive efficacy of the new dihydro-pyridine derivative nilvadipine given once daily was compared in two r and omized , double-blind studies with that of hydrochlorothiazide/triamterene ( HCT/T ) and of enalapril . In the first study , arterial pressures were compared after 4 weeks of therapy with nilvadipine ( 16 mg q.d . ) or HCT/T ( 25/50 mg q.d . ) in patients with mild-to-moderate hypertension in a parallel-group design . The combination of both treatments was administered after 4 weeks if diastolic arterial pressures were < 90 mm Hg . The blood pressure ( BP ) in the nilvadipine group ( n = 125 ) was 161/102 ± 17/7 ( mean ± SD ) mm Hg after a 2-week placebo period and decreased after 4 weeks by – 16/– 13 ± 22/12 mm Hg . The BP decreased in the HCT/T group ( n = 124 ) compared to the nilvadipine group to a similar degree ( p = 0.91 , n.s . ) from 160/103 ± 17/8 mm Hg by −17/-13 ± 18/11 mm Hg . A combination therapy was started after 4 weeks in 39 patients in the nilvadipine group and in 34 patients in the HCT/T group . This led independently of the treatment sequence , to a similar decrease in BP in the nilvadipine group ( – 17/7 ± 16/10 mm Hg ) and in the HCT/T group ( -12/9 ± 16/9 mm Hg ) . In the second study , the antihypertensive effect of nilvadipine ( 1 x 8 mg ) was compared with that of enalapril ( 1x10 mg ) in a r and omized , double-blind , crossover design . Sixty-one patients with essential hypertension ( WHO I – II ) were treated over two 4-week periods following placebo periods of 2 weeks . Nonresponders ( BP < 90 mm Hg ) were subsequently treated for an additional 4 weeks with a combination of both drugs given at the same dosage . The BP decreased to a similar degree after 4 weeks on nilvadipine from 175/108 ± 13/7 mm Hg by −19/-13 mm Hg and from 176/107 ± 13/6 mm Hg by −21/-13 mm Hg after 4 weeks on enalapril to 156/95 + 14/ 9 mm Hg and 155/94 ± 16/10 mm Hg , respectively . Goal diastolic BPs < 90 mm Hg were not achieved with monotherapy in 27 patients , but 15 of these 27 patients responded favorably to a combination of nilvadipine and enalapril  with diastolic BPs < 90 mm Hg . Combination therapy caused a decrease in the diastolic BP of −14/-13 mm Hg . In conclusion , nilvadipine administered once daily was as effective as  hydrochlorothiazide or enalapril  in lowering the BP . In combination with a diuretic , the sequence of treatments , i.e. , diuretic first or nilvadipine first , had no influence on antihypertensive efficacy . The combination of calcium antagonist and diuretic was as effective as that of the calcium antagonist with enalapril
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 .