Antihypertensive Effect of Felodipine or Hydralazine When Added to β-Blocker Therapy

Hansson, Lennart; Dahlöf, Björn; Gudbrandsson, Thorkell; Hellsing, Torsten; Kullman, S; Kuylenstierna, Jörgen; Leppert, Jerzy; Møller, Birger R.; Skogström, Kay; Svensson, Anders; Svensson, Olof; Ugander, Lars

doi:10.1097/00005344-198807000-00013

Cited by 13 publications

(4 citation statements)

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“…Introduction of new drug have improved quality of life for these patients. A number of drugs in various combinations [10][11][12] are generally used for effective longterm management. Therefore, drug utilization studies, which evaluate, analyze the medical, social and economic outcomes of the drug therapy, are more meaningful and observe the prescribing attitude of physicians with the aim to provide drugs rationally, and play a pivotal role in formulating and implementing such strategies.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of prescribing patterns in diabetic and hypertensive patients in a South Delhi Hospital

Pandey

Hoda

Aqil

et al. 2014

Int J Basic Clin Pharmacol

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Section: Introductionmentioning

confidence: 99%

Evaluation of prescribing patterns in diabetic and hypertensive patients in a South Delhi Hospital

Pandey

Hoda

Aqil

et al. 2014

Int J Basic Clin Pharmacol

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“…Higher closes, up to 80 mg a clay, causing high plasma concentrations, were used to get similar antihypertensive effects in these patients with severe renal hypertension as in patients with less severe hyper-tension and normal renal function [13]. The more severe hypertension may be more difficult to treat because of more pronounced hypertrophy in the resistance vessel x'vall [14].…”

Section: Discussionmentioning

confidence: 99%

Felodipine in the treatment of patients with severe hypertension and impaired renal function

Larsson

Lindsjö

Danielsson

et al. 1990

Cardiovasc Drug Ther

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Twenty-three patients with severe hypertension and impaired renal function were included in an open study of the efficacy and tolerance of felodipine treatment over 6 months. All patients were previously treated with a diuretic, a beta blocker, and a vasodilator, and eight of them also received an ACE inhibitor. At the start of felodipine treatment the previously used vasodilator was withdrawn. In nine patients the concomitant antihypertensive treatment was reduced during the study. The glomerular filtration rate (GFR), as 51Cr EDTA clearance, was determined before and at the end of the study. The blood pressure (BP) and heart rate (HR) were recorded at all clinical visits in the morning 12 hours after the evening dose of felodipine and 2 hours after the morning dose. Plasma concentrations of felodipine were measured at every visit before the morning dose and 2 hours after dose. The BP was reduced after felodipine was substituted for the previously used vasodilator. A significant additional anti-hypertensive effect was recorded 2 hours after the dose and amounted to -37 +/- 22/-15 +/- 12 mmHg (p = 0.0001/p = 0.0002) at 6 months. The effect measured 12 hours after the dose was less pronounced and was -11 +/- 28/-6 +/- 10 mmHg (p = 0.15/p = 0.03). Mean GFR was unchanged during the study, 38 +/- 19 versus 38 +/- 19 ml/min (n = 16). There was a sixfold interindividual variation in the trough plasma concentrations at steady state at the same drug dosage. Higher plasma concentrations seemed to be required to achieve the same antihypertensive effects as in patients with less severe hypertension and normal renal function.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…In contrast, a randomized trial of 120 patients with essential hypertension found that the combination of felodipine with a β-blocker reduced blood pressure to a greater extent when compared to the combination of hydralazine with a β-blocker (10-19 mm Hg greater reduction in systolic blood pressure); however, it should be noted that there were maximum doses used for each group (10 mg twice daily for felodipine and 50 mg twice daily for hydralazine). 25…”

Section: Hydralazinementioning

confidence: 99%

Direct Vasodilators and Sympatholytic Agents

McComb

Chao

2015

J Cardiovasc Pharmacol Ther

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Direct vasodilators and sympatholytic agents were some of the first antihypertensive medications discovered and utilized in the past century. However, side effect profiles and the advent of newer antihypertensive drug classes have reduced the use of these agents in recent decades. Outcome data and large randomized trials supporting the efficacy of these medications are limited; however, in general the blood pressure-lowering effect of these agents has repeatedly been shown to be comparable to other more contemporary drug classes. Nevertheless, a landmark hypertension trial found a negative outcome with a doxazosin-based regimen compared to a chlorthalidone-based regimen, leading to the removal of α-1 adrenergic receptor blockers as first-line monotherapy from the hypertension guidelines. In contemporary practice, direct vasodilators and sympatholytic agents, particularly hydralazine and clonidine, are often utilized in refractory hypertension. Hydralazine and minoxidil may also be useful alternatives for patients with renal dysfunction, and both hydralazine and methyldopa are considered first line for the treatment of hypertension in pregnancy. Hydralazine has also found widespread use for the treatment of systolic heart failure in combination with isosorbide dinitrate (ISDN). The data to support use of this combination in African Americans with heart failure are particularly robust. Hydralazine with ISDN may also serve as an alternative for patients with an intolerance to angiotensin antagonists. Given these niche indications, vasodilators and sympatholytics are still useful in clinical practice; therefore, it is prudent to understand the existing data regarding efficacy and the safe use of these medications.

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Antihypertensive Effect of Felodipine or Hydralazine When Added to β-Blocker Therapy

Cited by 13 publications

References 0 publications

Evaluation of prescribing patterns in diabetic and hypertensive patients in a South Delhi Hospital

Evaluation of prescribing patterns in diabetic and hypertensive patients in a South Delhi Hospital

Felodipine in the treatment of patients with severe hypertension and impaired renal function

Direct Vasodilators and Sympatholytic Agents

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