Effects of nifedipine versus hydralazine on sympathetic activity and cardiac function in patients with hypertension persisting on diuretic plus beta-blocker therapy

Fh, Leenen; Rj, Burns; Mg, Myers; Frankel, David

doi:10.1007/bf01857760

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…However, a different picture emerges during long-term treatment. In 15 hypertensive patients, treatment for 9 weeks with nifedipine tablet (20-40 mg twice a day) caused larger decreases in BP compared with hydralazine (25-100 mg twice a day) ( Table 2) [26]. Nifedipine increased supine plasma NE only to a minor extent, whereas hydralazine resulted in a significant increase in supine NE level [26].…”

Section: Dihydropyridines and Sympathetic Activity In Humans: Evidencmentioning

confidence: 96%

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Central sympathoinhibitory effects of calcium channel blockers

Leenen

Ruzicka

Huang

2001

Current Science Inc

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It is generally assumed that the arterial vasodilation induced by inhibition of Ca(2+) influx into vascular smooth muscle cells represents the main mechanism for the hypotensive effect of dihydropyridine calcium channel blockers. Increases in sympathetic tone have been related to activation of the arterial baroreflex by rapid lowering of blood pressure. This review highlights new findings in two areas. First, in animal studies, direct central administration of dihydropyridines such as nifedipine or amlodipine lowers sympathetic nerve activity and thereby blood pressure. Peripheral administration of nifedipine or amlodipine at low rates appears to result in gradual accumulation of drug in the central nervous system, and also causes lowering of sympathetic nerve activity and thereby lowering of blood pressure (rather than by arterial vasodilation). Second, in hypertensive humans treated with long-acting dihydropyridines and presumably little activation of the arterial baroreflex, some studies have demonstrated lowering of sympathetic activity (as assessed by plasma norepinephrine), but others reported increases (as assessed by plasma norepinephrine or microneurography). This sympathoexcitatory response may be due to activation of the renin-angiotensin system, particularly at higher doses.

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Section: Dihydropyridines and Sympathetic Activity In Humans: Evidencmentioning

confidence: 96%

“…Effects of 9 weeks of treatment with nifedipine versus hydralazine on supine and standing blood pressure and plasma norepinephrine in 15 patients with hypertension persisting on diuretic plus beta-blocker*Data from Leenen et al[26]. *Values are mean ± SEM (n = 15).…”

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confidence: 98%

Central sympathoinhibitory effects of calcium channel blockers

Leenen

Ruzicka

Huang

2001

Current Science Inc

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“…29 –31 However, a few studies did suggest that add-on therapy with a DHP-CCB was more efficacious than add-on therapy with hydralazine. 32 –34…”

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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Preferred Fourth-Line Pharmacotherapy for Resistant Hypertension: Are We There Yet?

et al. 2017

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Resistant hypertension (RH) is defined as blood pressure (BP) that remains above target levels despite adherence to at least three different antihypertensive medications, typically including a diuretic. Epidemiological studies estimate that RH is increasing in prevalence, and is associated with detrimental health outcomes. The pathophysiology underlying RH is complex, involving multiple, overlapping contributors including activation of the renin-angiotensin aldosterone system and the sympathetic nervous system, volume overload, endothelial dysfunction, behavioural and lifestyle factors. Hypertension guidelines currently recommend specific pharmacotherapy for 1st, 2nd and 3rd-line treatment, however no specific fourth-line pharmacotherapy is provided for those with RH. Rather, five different antihypertensive drug classes are generally suggested as possible alternatives, including: mineralocorticoid receptor antagonists, α1-adrenergic antagonists, α2-adrenergic agonists, β-blockers, and peripheral vasodilators. Each of these drug classes vary in their efficacy, tolerability and safety profile. This review summarises the available data on each of these drug classes as a potential fourth-line drug and reveals a lack of robust clinical evidence for preferred use of most of these classes in the setting of RH. Moreover, there is a lack of direct comparative trials that could assist in identifying a preferred fourth-line pharmacologic approach and in providing evidence for hypertensive guidelines for adequate treatment of RH.

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Effects of nifedipine versus hydralazine on sympathetic activity and cardiac function in patients with hypertension persisting on diuretic plus beta-blocker therapy

Cited by 7 publications

References 27 publications

Central sympathoinhibitory effects of calcium channel blockers

Central sympathoinhibitory effects of calcium channel blockers

Direct Vasodilators and Sympatholytic Agents

Preferred Fourth-Line Pharmacotherapy for Resistant Hypertension: Are We There Yet?

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