nifedipine vs the ace inhibitors in hypertension

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Nifedipine vs the ACE inhibitors in Hypertension Nifedipine and lisinopril are equipotent but lisinopril has fewer adverse effects ... The antihypertensive efficacies of lisinopril and nifedipine were compared in a double-blind study. After a 2-week placebo run-in, 45 patients with essential hypertension (supine diastolic BP 95- 130mm Hg) randomly received either lisinopril 20-80mg once daily (n :: 30) or a slow release formulation of nifedipine 20-40mg bid (15) for 12 weeks . After 12 weeks' treatment , supine BP was reduced from 178/ 109 to 148/ 88mm Hg in lisinopril recipients and from 185/110 to 151/89mm Hg in nifedipine recipients (p < 0.01).18/29 (62%) lisinopril and 10/13 (76%) nifedipine recipients achieved a supine diastolic BP .:::: 90mm Hg. HR increased slightly in both treatment groups. Two nifedipine recipients withdrew from the study because of severe headache (n :: 1) or ankle swelling and flushing (1) . Four lisinopril and 8 nifedipine recipients experienced adverse effects (p < 0. 01 between treatment groups). Thus, lisinopril and nifedipine have comparable antihypertensive efficacy, but lisinopril appears to be better tolerated. Richardson PJ. Meany TB . Johnston GO . Kondowe G. Grimmer SFM. et al Journal of Cardiovascular Pharmacolo9Y 10 (Suppl 10) S96-S98. 1987 '25' .. . and nifedipine and enalapril have similar antihypertensive efficacies in elderly patients A randomised single-blind study was conducted to compare the efficacy and tolerability of nifedipine and enalapril in 12 elderly patients with hypertension (supine diastolic BP > 95mm Hg). After a 2-week treatment free run-in, patients received either a slow release formulation of nifedipine 20-60mg twice daily or enalapril 10-40mg once daily, for 4 weeks. After a 1 -week washout period, patients crossed over to the alternate treatment for a further 4 weeks. Mean supine BP was reduced from 197/121mm Hg at baseline to 153/93 mm Hg and 163/100mm Hg (p < 0.01) after 4 weeks of nifedipine and enalapril treatment, respectively. The hypertensive action of nifedipine was evident after 1 week compared to 3-4 weeks with enalapril Nifedipine caused a significant (p < 0. 05) rise in HR compared with enalapril Both nifedipine and enalapril therapy resulted in increased plasma renin activity. Neither treatment altered plasma norepinephrine levels, but epinephrine levels were increased with nifedipine compared to enalapril (p < 0.02). Plasma glucose was reduced significantly with enalapril but not nifedipine. There were no other significant biochemical changes. Two patients withdrew from nifedipine therapy because of severe postural hypotension (n :: 1) and severe constipation (1). Other adverse effects reported with nifedipine included mild flushing (n :: 4) , disturbances of concentration (2) and severe ankle swelling (1) _ One nifedipine recipient died suddenly of a cerebrovascular accident. Two patients in the enalapril group reported transient postural dizziness. 'In summary, long acting nifedipine and enalapril have similar antihypertensive effects in elderly hypertensive patients . . .' but 'whether the long term benefit: risk profile of these agents in the elderly is superior to more established antihypertensive agents, remains to be determined_' Gilchrist NL. Nicholls MG. Ewer Te Livesey JH . Sainsbury R Journal of Human Hypertension 2 33·39. Jun 1988 0156-2703/ 88/ 0730-0013/ 0S01 .00/ 0 © ADIS Press INPHARMA' 30 July 1988 13

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Page 1: Nifedipine vs the ACE inhibitors in Hypertension

Nifedipine vs the ACE inhibitors in Hypertension Nifedipine and lisinopril are equipotent but lisinopril has fewer adverse effects ...

The antihypertensive efficacies of lisinopril and nifedipine were compared in a double-blind study. After a 2-week placebo run-in, 45 patients with essential hypertension (supine diastolic BP 95-130mm Hg) randomly received either lisinopril 20-80mg once daily (n :: 30) or a slow release formulation of nifedipine 20-40mg bid (15) for 12 weeks .

After 12 weeks' treatment , supine BP was reduced from 178/ 109 to 148/ 88mm Hg in lisinopril recipients and from 185/110 to 151/89mm Hg in nifedipine recipients (p < 0.01).18/29 (62%) lisinopril and 10/13 (76%) nifedipine recipients achieved a supine diastolic BP .:::: 90mm Hg. HR increased slightly in both treatment groups. Two nifedipine recipients withdrew from the study because of severe headache (n :: 1) or ankle swelling and flushing (1). Four lisinopril and 8 nifedipine recipients experienced adverse effects (p < 0.01 between treatment groups).

Thus, lisinopril and nifedipine have comparable antihypertensive efficacy, but lisinopril appears to be better tolerated. Richardson PJ. Meany TB. Johnston GO . Kondowe G. Grimmer SFM. et al Journal of Cardiovascular Pharmacolo9Y 10 (Suppl 10) S96-S98. 1987 '25'

.. . and nifedipine and enalapril have similar antihypertensive efficacies in elderly patients A randomised single-blind study was conducted to compare the efficacy and tolerability of nifedipine

and enalapril in 12 elderly patients with hypertension (supine diastolic BP > 95mm Hg). After a 2-week treatment free run-in, patients received either a slow release formulation of nifedipine 20-60mg twice daily or enalapril 10-40mg once daily, for 4 weeks. After a 1 -week washout period, patients crossed over to the alternate treatment for a further 4 weeks.

Mean supine BP was reduced from 197/121mm Hg at baseline to 153/93mm Hg and 163/100mm Hg (p < 0.01) after 4 weeks of nifedipine and enalapril treatment , respectively . The hypertensive action of nifedipine was evident after 1 week compared to 3-4 weeks with enalapril Nifedipine caused a significant (p < 0.05) rise in HR compared with enalapril Both nifedipine and enalapril therapy resulted in increased plasma renin activity . Neither treatment altered plasma norepinephrine levels, but epinephrine levels were increased with nifedipine compared to enalapril (p < 0.02). Plasma glucose was reduced significantly with enalapril but not nifedipine. There were no other significant biochemical changes.

Two patients withdrew from nifedipine therapy because of severe postural hypotension (n :: 1) and severe constipation (1). Other adverse effects reported with nifedipine included mild flushing (n :: 4) , disturbances of concentration (2) and severe ankle swelling (1)_ One nifedipine recipient died suddenly of a cerebrovascular accident. Two patients in the enalapril group reported transient postural dizziness.

'In summary, long acting nifedipine and enalapril have similar antihypertensive effects in elderly hypertensive patients . . .' but 'whether the long term benefit: risk profile of these agents in the elderly is superior to more established antihypertensive agents, remains to be determined_' Gilchris t NL. Nicholls MG. Ewer Te Livesey JH . Sainsbury R Journal of Human Hypertension 2 33·39. Jun 1988

0156-2703/ 88/ 0730-0013/ 0S01 .00/ 0 © ADIS Press INPHARMA' 30 July 1988 13