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 .
Fixed dose combination of perindopril and indapamide improves peripheral vascular function in essential hypertensive patients.
BACKGROUND The effect on endothelium-dependent and independent vasodilation of 24-week treatment with a fixed-dose combination of perindopril/indapamide ( 2/0.625 mg , daily ) and atenolol ( 50 mg , daily ) , was evaluated in 62 untreated essential hypertensive patients according a double-blind , parallel group , r and omized study . METHODS Brachial artery flow-mediated dilation ( FMD ) , response to sublingual glyceril trinitrate ( GTN , 25 microg ) and to cold pressor test ( CPT )  were measured at baseline and after treatments at 12 and 24 weeks , as change in diameter from ultrasound scans by a computerized system . RESULTS Blood pressure ( BP ) was ( P < 0.001 ) reduced in both groups , but to a greater ( P < 0.01 ) extent in the perindopril/indapamide group . After 24 weeks , FMD was significantly increased ( P < 0.01 ) by perindopril/indapamide ( from 5.0 + /- 2.1 to 6.0 + /- 1.7 % ) but not by atenolol ( from 5.1 + /- 1.8 to 5.5 + /- 1.8 % ) . Improvement in FMD was not statistically related to BP reduction . Response to GTN was also significantly ( P < 0.05 ) increased by perindopril/indapamide ( from 6.2 + /- 1.9 to 6.9 + /- 1.7 % ) , but not by atenolol ( from 6.1 + /- 2.8 to 6.6 + /- 2.6 % ) . Improvement in GTN response was significantly ( P < 0.05 ) related to BP reduction . Response to CPT was significantly increased ( P < 0.001 ) by perindopril/indapamide after 12 and 24 weeks , whereas  atenolol  significantly ( P < 0.05 ) improved it only after 24 weeks . CONCLUSIONS Treatment with perindopril/indapamide improves endothelium-dependent vasodilation in comparison with atenolol . This improvement was observed without significant relations with BP changes , suggesting a pressure-independent effect . Improvement in endothelium-independent and sympathetic-associated vasodilation was also observed . These results suggests that long term therapy with a fixed-dose combination of perindopril/indapamide affords vascular protection in hypertensive patients
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 .