Improving the therapeutic balance between efficacy and tolerability in antihypertensive drugs--the rationale and benefits of combining felodipine and metoprolol.

Several studies, most recently the Starnberg Study on Epidemiology of Parkinsonism and Hypertension in the Elderly (STEPHY), have shown that BP is not adequately controlled in a substantial proportion of treated hypertensive patients. This finding highlights the need for new treatment strategies that are sufficiently effective throughout the dosing interval, well tolerated, and available in a convenient, once-daily regimen. Monotherapy with any individual drug class is often unable to fulfil all of these criteria in more than a minority of patients. In contrast, once-daily therapy with rational combinations of antihypertensive drugs offers a promising approach to improving treatment of hypertension. The highly vascular selective calcium antagonist felodipine and the cardioselective beta-blocker metoprolol have complementary mechanisms of action, making them appropriate for use together in the management of hypertension. A new extended-release (ER) formulation, combining felodipine, 5 mg, and metoprolol, 50 mg*, has therefore been developed. This formulation has been shown to provide significantly greater reductions and higher antihypertensive response rates than either agent used alone. This high efficacy is achieved with maintained good tolerability. In comparative trials, felodipine-metoprolol has also been shown to be more effective than combination treatment with nifedipine and atenolol, or captopril and hydrochlorothiazide. It is concluded that the felodipine-metoprolol ER tablet offers predictably high 24 h antihypertensive response rates from a convenient and well-tolerated once-daily dose.