, Volume 3, Issue 1 Supplement, pp 319-325

Calcium-channel blockade (nitrendipine) in combination with ACE inhibition (captopril) in the treatment of mild to moderate hypertension

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The antihypertensive efficacy of a combination of calcium-channel blockers and angiotensin-converting-enzyme (ACE) inhibitors in severe primary hypertension is well known, but a synergistic action of this drug combination in mild to moderate primary hypertension is still not established. Therefore, the sim of the present study was to evaluate the efficacy and telerability of monotherapy with nitrendipine (20 mg) or captopril (100 mg), and of their combination (nitrondipine 10 mg plus captopril 50 mg), in patients suffering from mild to moderate primary hypertension, according to a single-blind, randomized, placebe-controlled design.

After the first 4-week monotherapy period, both nitrendipine and captopril induced a significant decrease in systolic and diastolic blood pressure (BP) (p<0.001). Furthermore, nitrendipine caused a significant increase in heart rate (HR), while no change in HR was observed in patients treated with captopril. Several side effects were observed, both in the nitrendipine-treated patients (facial flushing, headache, malleolar edema) and in the captopril- treated patients (initial hypotension, dizziness, gastrointestinal disorders). However, these side effects were mild and were well tolerated.

In the second combined 4-week therapy period, systolic and diastolic BP of patients treated with 10 mg nitrendipine combined with 50 mg captopril continued to decrease to a degree significantly lower (p<0.001) than that observed at the end of the monotherapy period. Simultaneously, no change in HR values occurred when compared to basal values. Furthermore, the incidence and intensity of some side effects obseryed during the combined therapy period were lower than those of the monotherapy period. These data are in agreement with the hypothesis that the combination of calcium-channel blockers and ACE inhibitors could have a synergistic antihypertensive effect, and, particularly, that the combination of 10 mg nitrendipine and 50 mg captopril appears to be a very effective and well-tolerated regimen for the treatment of mild to moderate primary hypertension.