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 .
Blood Pressure-Lowering Efficacy of Amiloride versus Enalapril as Add-On Drugs in Patients with Uncontrolled Blood Pressure Receiving Hydrochlorothiazide
A large proportion of patients with hypertension need a second drug to reach satisfactory control of blood pressure ( BP ) , but there are few well- design ed controlled trials comparing the efficacy of drugs added as a second option . In a double-blind r and omized clinical trial , 82 patients with uncontrolled BP , receiving hydrochlorothiazide 25 mg daily , were selected to receive amiloride 2.5–5 mg/day ( n = 39 ) or enalapril 10–20 mg/day ( n = 43 ) .  Ambulatory blood pressure monitoring ( ABPM ) was done before and after 12-weeks of treatment . Office BP was measured in the 4th , 8th , and 12th weeks . The doses of amiloride and enalapril were doubled in the fourth week , and propranolol was added in the 8th week if office BP was above 140/90 mm Hg . There was a greater BP reduction in patients treated with enalapril . The ABPM δ values between the groups were 3.6 ± 2.2 , 3.9 ± 2.2 , and 1.1 ± 2.7 mmHg for 24-h , daily , and nightly systolic blood pressure , respectively , favoring enalapril . For diastolic blood pressure ( DBP ) , the deltas were 1.7 ± 2.0 , 3.2 ± 1.5 , and 1.2 ± 1.9 mmHg , respectively ( p = 0.039 for daily DBP ) . Office SBP decreased more and sooner in patients allocated to enalapril ( p = 0.003 ) . More patients taking amiloride required propranolol to control BP ( p = 0.035 ) . Potassium increased 0.3 mEq/L on the average in both groups . Cough , albeit predominantly mild , was reported more frequently by participants treated with enalapril . We conclude that enalapril is more effective than amiloride to lower BP of patients on hydrochlorothiazide with uncontrolled BP . Trial registration : Clinical Trials.gov identifier : NCT00394394
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 .