Hemodynamic interactions between diuretics and calcium antagonists in the treatment of hypertensive patients.
To investigate the hypotensive and hemodynamic effects of plain and extended-release (ER) formulations of felodipine added to a diuretic in the treatment of moderate essential hypertension, we studied 18 patients in a randomized, double-blind, cross-over study. Blood pressure (BP), heart rate (HR), hemodynamics (bioimpedance), foot volume (Archimedes' principle), and symptoms were evaluated after a 1-month placebo washout, after 1-month's treatment with a fixed combination of hydrochlorothiazide 50 mg plus amiloride 5 mg (HA), and then after felodipine 5 mg twice daily (F) or felodipine ER 10 mg daily (FER) (double-blind phase), each given for 2 weeks in a randomized sequence together with the diuretic. All measurements were performed at the end of the dosing interval. At baseline, supine SBP/DBP was 175.6 +/- 12.9/113.4 +/- 8.1 mmHg; HR was 77.3 +/- 7.0 beats/min; CO was 5.3 +/- 1.4 l/min; SVR was 2166 +/- 707 dynes sec. cm5, and foot volume was 433 +/- 195 ml (FV). HA induced a reduction (p less than 0.05) in BP; one patient had a DBP = 90 mmHg and was excluded from the combination study; eight patients had a DBP reduction of greater than or equal to 10 mmHg (responders), and their blood pressure was mainly reduced by a fall in SVR. HR, CO, and FV were unchanged. The addition of felodipine to a diuretic induced a further significant (p less than 0.001) reduction in BP with respect to HA alone, with no differences between F and FER. All patients had a DBP fall greater than 10 mmHg, which had no relationship to their response to the diuretic.(ABSTRACT TRUNCATED AT 250 WORDS)
Di Somma
S
S
Physiopathology Institute University, La Sapienza, Rome, Italy.
Liguori
V
V
Petitto
M
M
Cavallotti
G
G
Savonitto
S
S
de Divitiis
O
O
D000328:Adult; D004232:Diuretics / Q000008:administration & dosage / Q000494:pharmacology*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D015736:Felodipine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged
D004232:Diuretics; D015736:Felodipine