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 diltiazem and metoprolol on blood pressure, adverse symptoms and general well-being
Summary General well-being , adverse effects and antihypertensive efficacy have been investigated in a double blind , parallel-group , dose-response multicentre study of diltiazem and metoprolol monotherapy for hypertension . 128 patients with primary hypertension were included from 10 participating centres . The patients were r and omized to receive oral diltiazem 120–240–360 mg/day or metoprolol 50–100–200 mg/day . Each dose was given for a 4-week period as a forced titration regime . In all 119 patients , 59 and 60 , respectively , on diltiazem and metoprolol completed the study protocol . There were dose-dependent reductions in supine and st and ing blood pressures ( BP ) after both diltiazem and metoprolol therapy . In the diltiazem group , supine BP was reduced by 10 (11)/10 ( 6 ) mm Hg ( SBP/DBP ) at the highest dose level , and the corresponding values for the metoprolol group were 7 (16)/8 ( 9 ) mm Hg ( SBP/DBP ) . Target pressures ( DBP ≤ 90 mm Hg and /or a reduction in DBP of ≥ 10 % ) were reached in 63 % and 48 % of the patients , respectively . The incidence and severity of dose-dependent adverse effects , as evaluated by spontaneous reports or open and direct question ing , did not differ between treatments . Subjective well-being , evaluated by a self-administered question naire , the MSE-profile , did not differ significantly between diltiazem and metoprolol therapy . However , after an initial slight deterioration , contentment and vitality tended to improve with increasing doses of diltiazem , while a dose-related deterioration in these variables was observed on metoprolol therapy . At the highest dose levels , contentment and vitality tended to be better in the diltiazem than the metoprolol group . Thus , diltiazem and metoprolol in daily doses of 120–360 mg and 50–200 mg , respectively , produce comparable and parallel reductions in supine and st and ing BP . However , while subjective well-being tended to improve with increasing doses of diltiazem , there was a negative trend for metoprolol . It is concluded that diltiazem , given as monotherapy to hypertensive patients , does not impair subjective well-being
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 .