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
Fleckenstein A. History of calcium antagonists. Circ Res 1983;52(Suppl 1):3–16.
MacGregor GA. Hypertension. In: Krebs R, ed. Treatment of cardiovascular diseases by Adalat. New York: Schattauer, 1986:231–258.
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.
Blaustein MP. Sodium ions, calcium ions, blood pressure regulation and hypertension; a reassessment and a hypothesis. Am J Physiol 1977;232(3):C165-C173.
Robinson BF. Altered calcium handling as a cause of primary hypertension. J Hyperten 1984;2:453–460.
Lederballe-Pedersen O, Mikkelsen E. Acute and chronic effects of nifedipine in arterial hypertension. Eur J Clin Pharmacol 1978;14:375–381.
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.
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.
Mac Gregor GA, Sagnella GA, MacRae KD. Misleading paper about misleading statistics. Lancet 1985;1:926–927.
Erne P, Bolli P, Bertel O, et al. Factors influencing the hypertensive effect of calcium antagonists. Hypertension 1983;5:97–102.
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.
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.
Bertel O, Cjonen D, Radu EW, Muller J, Lang C, Dubach UC. Nifedipine in hypertensive emergencies. Br Med J 1983;286:19–21.
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.
Landmark K. Antihypertensive and metabolic effects of long-term therapy with nifedipine slow-release tablets. J Cardiovasc Pharmacol 1985;7:12–17.
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.
Eggertsen R, Hansson L. Effects of treatment with nifedipine and metoprolol in essential hypertension. Eur J Clin Pharmacol 1982;21:389–390.
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.
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.
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.
MacCarthy EP. Dihydropyridines and beta-adrenoceptor agonists as combination treatment in hypertension. J Hyperten 1987;5(Suppl 4):S133-S137.
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.
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.
Singer DRJ, Markandu ND, Shore AC, MacGregor GA. Captopril and nifedipine in combination for moderate- to-severe essential hypertension. Hypertension 1987;9:629–633.
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.
MacGregorGA, PevahouseJB, CappuccioFP, MarkanduND. Nifedipine, sodium intake, diuretics, and sodium balance. Am J Nephrol 1987;7(Suppl 1):44–48.
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.
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.
YokoyamaS, KaburagiT. Clinical effects of intravenous nifedipine on renal function. J Cardiovasc Pharmacol 1983;5:67–71.
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.
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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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DOI: https://doi.org/10.1007/BF00148474