Tsukiyama H, Otsuka K, Yamamoto Y
J Int Med Res. 1984;12(3):154-62. doi: 10.1177/030006058401200304.
Thirteen patients with essential hypertension were started on pindolol 10-20 mg daily and twelve on nifedipine 20-60 mg daily. At the end of 6 weeks inadequate responders (B.P. greater than 140/90) were put onto combined treatment with both drugs, ten of the pindolol and six of the nifedipine patients being affected. Combined therapy then continued for a further 6-week period, while adequate responders (B.P. less than 140/90) continued with their initial drug. In addition to blood pressure, heart rate and cardiac index were also measured, and total peripheral resistance index was calculated. Where blood pressure decreased below 140/90 at the end of 12 weeks in patients on combined treatment, the original drug was withdrawn, leaving the patient on a single-drug regimen again, this time with the 'second compound'. This manoeuvre was followed by a rise in blood pressure in five out of eight patients in whom pindolol was withdrawn and in two out of six after nifedipine withdrawal. No definite conclusions can be drawn from these findings, and it may be that a better approach to the problem of poor responders would be to try each drug on its own before combining them, rather than combining first and then withdrawing the initial treatment. The increased peripheral resistance typical of essential hypertension was not adversely affected by either drug, while combined treatment had a beneficial effect on this parameter.
13例原发性高血压患者开始每日服用吲哚洛尔10 - 20毫克，12例患者开始每日服用硝苯地平20 - 60毫克。6周结束时，反应不佳者（血压高于140/90）接受两种药物的联合治疗，其中10例吲哚洛尔患者和6例硝苯地平患者受到影响。联合治疗再持续6周，而反应良好者（血压低于140/90）继续使用其初始药物。除了测量血压外，还测量了心率和心脏指数，并计算了总外周阻力指数。在接受联合治疗的患者中，若12周结束时血压降至140/90以下，则停用原来的药物，使患者再次采用单一药物治疗方案，这次使用的是“第二种药物”。在停用吲哚洛尔的8例患者中有5例以及停用硝苯地平的6例患者中有2例，出现了血压升高的情况。从这些发现中无法得出明确结论，对于反应不佳的问题，或许更好的方法是在联合用药之前先单独试用每种药物，而不是先联合用药然后再停用初始治疗药物。原发性高血压典型的外周阻力增加并未受到这两种药物的不利影响，而联合治疗对该参数有有益作用。
