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Nifedipine and hypertension: Roles of vasodilation and sodium balance

  • Hypertension
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Summary

Nifedipine reduces blood pressure predominantly by reducing systemic vascular resistance due to a direct vasodilating action on the arterioles. This peripheral vasodilation appears greater the more severe the hypertension. Nifedipine also causes a long-term loss of sodium, which may be an additive mechanism for the blood pressure fall. In patients who are not controlled on nifedipine alone, studies have demonstrated an additive effect of beta blockers and converting-enzyme inhibitors on blood pressure. There is controversy about whether diuretics have an additive effect on blood pressure in patients already on nifedipine.

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References

  1. Fleckenstein A. History of calcium antagonists. Circ Res 1983;52(Suppl 1):3–16.

    Google Scholar 

  2. MacGregor GA. Hypertension. In: Krebs R, ed. Treatment of cardiovascular diseases by Adalat. New York: Schattauer, 1986:231–258.

    Google Scholar 

  3. Robinson BF, Dobbs BJ, Bayley S. Response of forearm resistance vessels to verapamil and sodium nitroprusside in normotensive and hypertensive men: Evidence for a functional abnormality of vascular smooth muscle in primary hypertension. Clin Sci 1982;63:33–42.

    Google Scholar 

  4. Blaustein MP. Sodium ions, calcium ions, blood pressure regulation and hypertension; a reassessment and a hypothesis. Am J Physiol 1977;232(3):C165-C173.

    Google Scholar 

  5. Robinson BF. Altered calcium handling as a cause of primary hypertension. J Hyperten 1984;2:453–460.

    Google Scholar 

  6. Lederballe-Pedersen O, Mikkelsen E. Acute and chronic effects of nifedipine in arterial hypertension. Eur J Clin Pharmacol 1978;14:375–381.

    Google Scholar 

  7. Hulthen UL, Bolli P, Amann FW, Kiowski W, Buhler FR. Enhanced vasodilatation in essential hypertension by calcium channel blockade with verapamil. Hypertension 1982;4(Suppl 2):26–31.

    Google Scholar 

  8. Mac Gregor GA, Markandu ND, Rotellar C, Smith SJ, Sagnella GA. The acute response to nifedipine is related to pre-treatment blood pressure. Postgrad Med J 1983;59 (Suppl 2):91–94.

    Google Scholar 

  9. Mac Gregor GA, Sagnella GA, MacRae KD. Misleading paper about misleading statistics. Lancet 1985;1:926–927.

    Google Scholar 

  10. Erne P, Bolli P, Bertel O, et al. Factors influencing the hypertensive effect of calcium antagonists. Hypertension 1983;5:97–102.

    Google Scholar 

  11. Knorr A, Garthoff B. Differential influence of the calcium antagonist nitrendipine and the vasodilator hydralazine on normal and elevated blood pressure. Arch Int Pharmacodyn Ther 1984;269:316–322.

    Google Scholar 

  12. Yagil Y, Kobrin J, Stessman J, Ghanem B, Leibel D, Ben-Ishay D. Effectiveness of combined nifedipine and propranolol treatment in hypertension. Hypertension 1983;5 (Suppl II):II113-II117.

    Google Scholar 

  13. Bertel O, Cjonen D, Radu EW, Muller J, Lang C, Dubach UC. Nifedipine in hypertensive emergencies. Br Med J 1983;286:19–21.

    Google Scholar 

  14. Lederballe Pedersen O, Christensen NJ, Ramsch KD. Comparison of acute effects of nifedipine in normotensive and hypertensive man. J Cardiovasc Pharmacol 1980;2:357–366.

    Google Scholar 

  15. Landmark K. Antihypertensive and metabolic effects of long-term therapy with nifedipine slow-release tablets. J Cardiovasc Pharmacol 1985;7:12–17.

    Google Scholar 

  16. Cappuccio FP, Markandu ND, Tucker FA, MacGregor GA. Dose response and length of action of nifedipine capsules and tablets in patients with essential hypertension: A randomised crossover study. Eur J Clin Pharmacol 1986;30: 723–725.

    Google Scholar 

  17. Eggertsen R, Hansson L. Effects of treatment with nifedipine and metoprolol in essential hypertension. Eur J Clin Pharmacol 1982;21:389–390.

    Google Scholar 

  18. Yagil Y, Kobrin I, Stessman J, Ghanem J, Leibel B, Ben-Ishay D. Effectiveness of combined nifedipine and propranolol treatment in hypertension. Hypertension 1983;5 (Suppl II):II113-II117.

    Google Scholar 

  19. Husted SE, Nielsen HK, Christensen CK, Lederballe-Pederson O. Long-term therapy of arterial hypertension with nifedipine given alone or in combination with a beta-adrenoceptor blocking agent. Eur J Clin Pharmacol 1982; 22:101–103.

    Google Scholar 

  20. Singer DRJ, Markandu ND, Shore AC, MacGregor GA. Nifedipine and acebutolol in combination for the treatment of moderate to severe essential hypertension. J Human Hypertension 1987;1:31–37.

    Google Scholar 

  21. MacCarthy EP. Dihydropyridines and beta-adrenoceptor agonists as combination treatment in hypertension. J Hyperten 1987;5(Suppl 4):S133-S137.

    Google Scholar 

  22. Heagerty AM, Swales J, Baksi A, et al. Nifedipine and atenolol singly and combined for treatment of essential hypertension: Comparative multicentre study in general practice in the United Kingdom. Br Med J 1988;296:468–472.

    Google Scholar 

  23. Bayley S, Dobbs RJ, Robinson BF. Nifedipine in the treatment of hypertension: Report of a double-blind controlled trial. Br J Clin Pharmacol 1982;14:509–512.

    Google Scholar 

  24. Singer DRJ, Markandu ND, Shore AC, MacGregor GA. Captopril and nifedipine in combination for moderate- to-severe essential hypertension. Hypertension 1987;9:629–633.

    Google Scholar 

  25. Rosenthal J. Antihypertensive effects of nifedipine, mefruside and a combination of both substances in patients with essential hypertension. In: KaltenbackM, NeufeldHN, eds. New therapy of ishcaemic heart disease and hypertension. Amsterdam-Oxford-Princeton: Excerpta Medica 1982:175–181.

    Google Scholar 

  26. MacGregorGA, PevahouseJB, CappuccioFP, MarkanduND. Nifedipine, sodium intake, diuretics, and sodium balance. Am J Nephrol 1987;7(Suppl 1):44–48.

    Google Scholar 

  27. PoulterN, ThompsonAV, SeverPS. A double-blind, placebo-controlled, crossover trial to investigate the additive hypotensive effect of a diuretic (mefruside) to that produced by nifedipine. J Cardiovasc Pharmacol 1987;10(Suppl 10):S53-S56.

    Google Scholar 

  28. CappuccioFP, MarkanduND, TuckerFA, ShoreAC, MacGregorGA. A double-blind study of the blood pressure-lowering effect of a thiazide diuretic in hypertensive patients already on nifedipine and a beta blocker. J Hyperten 1987; 5:733–738.

    Google Scholar 

  29. YokoyamaS, KaburagiT. Clinical effects of intravenous nifedipine on renal function. J Cardiovasc Pharmacol 1983;5:67–71.

    Google Scholar 

  30. LeonettiG, GuspidiC, SampieriL, TerzoliA, ZanchettiA. Comparison of cardiovascular, renal, and humoral effects of acute administration of two calcium channel blockers in normotensive and hypertensive subjects. J Cardiovasc Pharmacol 1982;4:(Suppl 3):S319-S324.

    Google Scholar 

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MacGregor, G.A. Nifedipine and hypertension: Roles of vasodilation and sodium balance. Cardiovasc Drug Ther 3 (Suppl 1), 295–301 (1989). https://doi.org/10.1007/BF00148474

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