Nifedipine tablet vs. hydralazine in patients with persisting hypertension who receive combined diuretic and beta-blocker therapy

Myers, Martin G.; Leenen, Frans H. H.; Burns, Robert J.; Frankel, David

doi:10.1038/clpt.1986.63

Cited by 10 publications

(4 citation statements)

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“…As in our previously reported study [17], both drugs lowered BP, but nifedipine was significantly more effective than hydralazine in lowering systolic BP in this Values represent means = SEM (n -6), reported as the absolute values on placeb~ and the changes induced by nifedipine or hydralazine. EDV = LV end-diastolic volume.…”

Section: Discussionmentioning

confidence: 65%

“…Since arterial vasodilators such as hydralazine are generally used as part of a triple-therapy regimen [16], our studies focused on differences between the two classes of vasodilators persisting with combination therapy. Previously, we examined the antihypertensive efficacy of nifedipine tablets versus hydralazine in patients with hypertension persisting on combined diuretic and beta-blocker therapy; nifedipine was clearly more effective than hydralazine in lowering systolic BP [17]. We now report on the effects of nifedipine versus hydralazine on plasma catecholamines, ptasms renin activity (PRA), and left ventricular (LV) systolic and diastolic function.…”

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confidence: 94%

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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

et al. 1990

Cardiovasc Drug Ther

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In patients with hypertension persisting on combined diuretic and beta-blocker therapy, the effects of an additional 9-week therapy with a calcium antagonist (nifedipine) versus a classical arterial vasodilator (hydralazine) were compared for changes in blood pressure (BP), plasma catecholamines (n = 15), and left ventricular (LV) systolic and diastolic function (n = 6). Both drugs lowered BP, but nifedipine was significantly more effective in lowering systolic BP. Hydralazine increased both supine and standing plasma norepinephrine, nifedipine increased them only in the standing position and to a lesser extent. Patients on beta1-selective (n = 5) versus nonselective (n = 10) blockade showed similar responses. Left ventricular systolic function was not affected by hydralazine, whereas nifedipine increased the rate of ejection. In contrast, LV diastolic function was not affected by nifedipine, whereas hydralazine improved the peak filling rate. We conclude that arterial vasodilation by a calcium antagonist causes less sympathetic activation than caused by a classical arterial vasodilator. However, during short-term therapy in patients already on a diuretic and a beta blocker, nifedipine appears not to improve decreased LV diastolic function.

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Section: Discussionmentioning

confidence: 65%

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confidence: 94%

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

et al. 1990

Cardiovasc Drug Ther

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“…This case against nifedipine is not yet proven. Hypokalemia, although found in one study when nifedipine was combined with a diuretic and ~]blocker [30], could not be found in another study when a similar combination was made [31]. Sometimes glucose tolerance may actually improve [28].…”

Section: Nifedipine Side Effectsmentioning

confidence: 95%

Calcium channel antagonists part IV: Side effects and contraindications drug interactions and combinations

Opie

1988

Cardiovasc Drug Ther

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With the correct selection of drug and patient, the calcium antagonists as a group can be remarkably effective at relatively low cost of serious side effects. Almost all side effects are dose related. Minor side effects include those caused by vasodilation (flushing and headaches), constipation (verapamil), and ankle edema. Serious side effects are rare and result from improper use of these agents, as when intravenous verapamil (or diltiazem) is given to patients with sinus or atrioventricular nodal depression from drugs or disease, or nifedipine to patients with aortic stenosis. The potential of a marked negative inotropic effect is usually offset by afterload reduction, especially in the case of nifedipine which actually has the most marked negative inotropic effect. Yet caution is required when even calcium antagonists, especially verapamil, are given to patients with myocardial failure unless caused by hypertensive heart disease. Drug interactions of calcium antagonists occur with other cardiovascular agents such as alpha-adrenergic blockers, beta-adrenergic blockers, digoxin, quinidine, and disopyramide. The most marked interaction with digoxin is that with verapamil, which may raise digoxin levels by over 50%. Combination therapy of calcium antagonists with beta-blockers is increasingly common, and is probably safest in the case of dihydropyridines. Other combinations being explored are those with angiotensin-converting enzyme inhibitors and diuretics.

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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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Nifedipine tablet vs. hydralazine in patients with persisting hypertension who receive combined diuretic and beta-blocker therapy

Cited by 10 publications

References 0 publications

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

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

Calcium channel antagonists part IV: Side effects and contraindications drug interactions and combinations

Direct Vasodilators and Sympatholytic Agents

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