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 .
Lercanidipine, enalapril and their combination in the treatment of elderly hypertensive patients: placebo-controlled, randomized, crossover study with four ABPM
This double-blind , placebo-controlled , four-way balanced design crossover study included hypertensive patients aged 60–85 years with mean office-measured sitting systolic blood pressure ( SBP ) 160–179 mm Hg and daytime SBP ⩾135 mm Hg . After a 2-week run-in period , during which previous medications were discontinued , each patient received the following four treatments in r and omized order for 4 weeks each : lercanidipine 10 mg ( L ) , enalapril 20 mg ( E ) , lercanidipine 10 mg plus enalapril 20 mg ( L/E ) and placebo ( P ) . At the end of each treatment period , office trough blood pressure ( BP ) was measured and a 24-h Ambulatory Blood Pressure Monitoring ( ABPM ) was performed . Seventy-five patients ( mean age 66 years , office BP 168/92 mm Hg , daytime SBP 151 mm Hg ) were r and omized and 62 completed the study with four valid post-baseline ABPMs . The administration of P , L , E and L/E was associated with a mean 24-h SBP of 144 , 137 , 133 and 127 mm Hg , respectively . All active treatments significantly reduced the mean 24-h SBP in comparison with placebo , but L/E was significantly more effective than L and E alone . Similarly , office SBP was significantly more reduced with L/E ( −16.9 mm Hg ) than with L ( −5.0 mm Hg ) or E ( −5.9 mm Hg ) . A BP < 140/90 mm Hg was recorded in 18 % of patients with L , 19 % with E and 45 % with L/E. Two patients on P and two on L/E were withdrawn from the study due to adverse events . In conclusion , combination therapy with L/E  has additive antihypertensive effects on both ambulatory and office BP in elderly patients and is well tolerated
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 .