Treatment of resistant hypertension: 3 years of follow-up with the combination of verapamil and methyldopa.
A combination of verapamil (V), methyldopa (M), and hydrochlorothiazide (H) was tried in hypertensive patients resistant to the usual stepped-care therapy. After at least 60 days with a third-step regimen, placebo was added during the last 2 weeks. Twenty patients whose diastolic blood pressure (DBP) remained greater than 100 mm Hg were assigned to the study. During the initial titration period patients received increasing doses of V (240-480 mg) and M (500-1,500 mg). H was kept at 50 mg/day. Other previously administered drugs were gradually withdrawn. Goal pressure was DBP less than or equal to 95 mm Hg. Follow-up lasted 3 years. Sixteen patients participated in the investigation until the end and all but one reached the goal DBP. Mean systolic BP dropped from 187 +/- 17 to 150 +/- 15 mm Hg (p less than 0.05) and DBP from 118 +/- 12 to 90 +/- 9 mm Hg (p less than 0.01). Adverse effects were rare and mild. Other control measurements did not show any change except improvement of the electrocardiogram of 11 patients, and of the optic fundus of 10 patients. The number of drug unities to be taken dropped from 10 +/- 4 to 7 +/- 2 (p less than 0.05). The abovementioned combination seems to be useful in the control of resistant hypertension. Efficacy was sustained and tolerability was excellent. A potential to reverse target organ damage, namely of the heart and optic fundus, is suggested.
Spritzer
N
N
Hypertension Unit, Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil.
Spritzer
T S
TS
Rodrigues
R
R
D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008750:Methyldopa / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D014700:Verapamil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D008750:Methyldopa; D014700:Verapamil