Antihypertensive Agents Displaying Similar Efficacy Nifedipine twice daily is equivalent to indapamide once daily ...

In a randomised, double blind trial, 59 patients with moderate hypertension received either oral nifedipine (slow release) 20mg bid or oral indapamide 2.5mg once daily for 4 months. The treatments followed a l-month placebo run-in and were administered by the patients' general practitioner (n = 13).

Nineteen patients were excluded from the study because of side effects, lack of follow-up or normalisation of BP on placebo. In the remaining 18 patients taking nifedipine, mean supine BP was decreased from 165/104mm Hg to 148/86mm Hg after 4 months' therapy. In patients receiving indapamide (n = 22) mean supine BP fell from 164/100 to 152/87mm Hg. There were no significant differences between the 2 treatments> and heart rate and bodyweight were not changed by either drug. The side effects experienced were minor and transitory in most cases. Muscular cramps were more common with indapamide and headaches and tiredness were more commonly reported with nifedipine.

The authors concluded that nifedipine and indapamide appear to be effective antihypertensive agents tor the treatment of patients with moderate hypertension and are well tolerated. Chaignon M. Lucsko M. Rapoud JP. Aubert p, Guedon J Archives des Maladies du Coeur et des Valsseaux 78: 67-72, Nov 1985 [Translated from the original article published In French]

... and 2 ~-blockers, although equally effective, appear to act by different mechanisms In a double-blind study, 39 patients with untreated essential hypertension (WHO stage I) received either

metoprolol 100-300 mg/day (n = 19) or pindolol 5-15 mg/day (n = 17) for 6 months following a 6-week placebo run-in.

The 2 drugs achieved an equal reduction in BP in both the resting position (reduced 11 % with pindolol and 12% with metoprolol) and during exercise. Heart rate was reduced from 67 to 56 beats/min after 6 weeks in the metoprolol group but was not significantly changed in the pindolol group. By contrast, periphearal vascular resistance was reduced with pindolol and slightly but not significantly increased with metoprolol. Vascular resistence at maximal dilatatiol'l (induced by arterial occlusion and muscular work until exhaustion) was unchanged by either drug in the calf vascular bed but in the forearm was reduced by 17% with pindolol. The authors concluded that pindolol, by virtue of its intrinsic sympathomimetic activity, reduces BP mainly by lowering peripheral vascular resistance and allows a regression of the structural vascular changes of hypertension in the forearm vascular bed. Metoprolol appears to act primarily on the heart. Hansson L Ameflcan Journal of Cardiology 57 29C-31C. 12 Feb 1986

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