EFFICACY OF NIPRADILOL PLUS A CALCIUM-ANTAGONIST IN HYPERTENSIVE PATIENTS RESISTANT TO MONOTHERAPY WITH A CALCIUM-ANTAGONIST

The hypotensive effect of the combination of nipradilol with a calcium antagonist was studied in patients with essential hypertension in whom the calcium antagonist administered alone as the first choice was not effective. Blood pressure was monitored using a noninvasive portable automatic sphygmomanometer after the administration of nipradilol (3 mg, BID morning and evening) for two weeks with the calcium antagonist nilvadipine (4 mg, BID morning/evening), in eight patients (two men and six women; mean age, 70 +/- 11 years) with essential hypertension in whom the casual blood pressure was more than 160/90 mmHg during treatment with 4 mg of nilvadipine BID alone for two weeks. During the combined administration, a significant hypotensive effect was observed in both systolic and diastolic pressures for the entire day except at midnight, when the patients were asleep, as compared with the period when nilvadipine was administered alone. By cumulative percentage analysis, the 50% value in the systolic pressure decreased by 3 mmHg (2.0%) from 149 mmHg to 146 mmHg, and the diastolic pressure decreased by 8 mmHg (9.9%) from 81 to 73 mmHg after the combined administration, suggesting that this treatment has a greater hypotensive effect on diastolic pressure. In addition, this treatment reduced only high levels of systolic pressures with no hypotensive effect on low systolic pressures, but it reduced low as well as high diastolic pressures, although the reduction was more pronounced as the pressure was higher. From these results, the combined therapy of a dihydropyridine calcium antagonist and nipradilol is considered to reduce blood pressure, especially diastolic blood pressure, during the day and in the evening with little effect during sleep at night. Concerning heart rate, the administration of nipradilol with nilvadipine tended to elicit less bradycardia than nipradilol alone.