Nifedipine tablet vs. hydralazine in patients with persisting hypertension who receive combined diuretic and beta-blocker therapy.

The antihypertensive effects of a 20 mg tablet of nifedipine were compared with those of hydralazine in a randomized, double-blind, placebo-controlled study. Nineteen patients with a diastolic blood pressure (BP) between 95 and 120 mm Hg despite combined diuretic and beta-blocker therapy completed the protocol. After 2 weeks of placebo each subject received increasing doses of nifedipine (20, 40, and 60 mg b.i.d.) and hydralazine (25, 50, and 100 mg b.i.d.) if tolerated or until goal BP (supine and standing diastolic BP less than 85 mm Hg) was achieved. Both nifedipine and hydralazine significantly lowered supine BP from placebo baseline (146 +/- 3/96 +/- 2 mm Hg) to 119 +/- 3/80 +/- 2 and 129 +/- 2/81 +/- 2 mm Hg, respectively. The decrease in systolic BP with nifedipine was significantly lower than that with hydralazine at 9 weeks. Neither drug significantly altered heart rate. Mean left ventricular ejection fractions were similar for nifedipine (67% +/- 2%), hydralazine (69% +/- 3%), and placebo (66% +/- 2%). The nifedipine tablet appears to be an effective antihypertensive agent in patients whose BP remains high despite combined diuretic and beta-blocker therapy.