The Effects of Bendroflumethiazide Added to Nifedipine in Patients With Hypertension

Abstract

It has been suggested that a diuretic added to a calcium antagonist may not reduce blood pressure further in patients with hypertension. Bendroflumethiazide 5 mg was given to 17 patients with essential hypertension who had persistent mild to moderate hypertension despite treatment with nifedipine slow-release tablets 20 mg bid. One group received bendroflumethiazide before (N = 8) and the other after placebo (N = 9) in a double-blind, randomized cross-over trial. Supine blood pressure following active bendroflumethiazide administration was significantly reduced in both groups compared with trial entry (166/105 to 150/96 mm Hg, P less than .01; 170/108 to 156/98 mm Hg, P less than .01). A reduction in serum potassium level and a rise in serum uric acid concentration were seen with combined treatment. We cannot substantiate theoretic arguments for the ineffectiveness of a bendroflumethiazide-nifedipine combination on blood pressure.

Systolic Hypertension in Older Persons

“…33,34 Similarly, there is little synergy between thiazide diuretics and the dihydropyridine CCBs. 35,36 Reasonable evidence-based combinations might be a diuretic and an ACE inhibitor or ACE inhibitor and CCB.…”

Polytherapy with two or more antihypertensive drugs to lower blood pressure in elderly Ontarians. Room for improvement

“…These include thiazide diuretics with beta-blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers; betablockers with calcium channel blockers; and calcium channel blockers with ACE inhibitors or angiotensin receptor blockers. For other drug combinations, there is controversy over whether they have additive hypotensive effects (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33), and the combinations do not have regulatory approval to be combined in a single tablet for the purposes of blood pressure lowering (13,(17)(18)(19). Both the British Hypertension Society and the Canadian Hypertension Education Program endorse the combining of two antihypertensive drugs with proven additive hypotensive effect and advise against the use of unproven drug combinations in the absence of compelling indications arising from comorbid conditions, such as heart failure (11,12).…”

Resistant hypertension and the birmingham hypertension square

“…For example, there is little synergy between two renin system blocking drug classes, such as the ACE inhibitors and β-blockers [39,40]. Similarly, a combination of a dihydropyridine calcium channel blocker and a thiazide diuretic, which is often used to counteract the calcium channel blocker-induced ankle edema, is likely to be less effective in achieving optimal blood pressure control [41,42].…”