title: Mono- and combination therapy with felodipine or enalapril in elderly patients with systolic hypertension.
abstract: Using a randomised double-blind crossover design with Latin square allocation of treatments in 20 subjects (7 male, 13 female-ages: 61-87 years) with systolic hypertension, we investigated the efficacy and tolerability of once daily felodipine (extended release) 5-20 mg, enalapril 5-20 mg and their combination compared with placebo in four treatment phases each of 6 weeks duration. During each phase, doses were titrated to achieve a predose clinic supine systolic blood pressure of 140 mmHg or to a predetermined maximum dose. In both the felodipine and combination phases, predose supine and standing systolic and diastolic pressures were significantly reduced compared with the placebo phase (decrease in supine pressure: -13/-5 and -18/-7, respectively). Only predose supine diastolic pressure was significantly reduced (-3 mmHg) compared to placebo in the enalapril phase. In combination the effects of the two drugs on predose blood pressure were additive. There was a 40-60% increase in reported symptoms in the felodipine and combination phases compared with the placebo and enalapril phases. Thus, in elderly subjects with systolic hypertension, felodipine effectively reduces blood pressure throughout the dose interval but with vasodilator adverse effects. In contrast, enalapril is well tolerated but is less effective in reducing blood pressure throughout the whole dose interval.
authors.affiliation: Department of Clinical Pharmacology, Flinders Medical Centre, Bedford Park, Adelaide, Australia.
authors.forename: L M
authors.initials: LM
authors.lastname: Wing
authors.forename: A E
authors.initials: AE
authors.lastname: Russell
authors.forename: A L
authors.initials: AL
authors.lastname: Tonkin
authors.forename: R W
authors.initials: RW
authors.lastname: Watts
authors.forename: A J
authors.initials: AJ
authors.lastname: Bune
authors.forename: M J
authors.initials: MJ
authors.lastname: West
authors.forename: J P
authors.initials: JP
authors.lastname: Chalmers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D004338:Drug Combinations; D004656:Enalapril / Q000009:adverse effects / Q000627:therapeutic use*; D015736:Felodipine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013599:Systole
chemical_list: D004338:Drug Combinations; D004656:Enalapril; D015736:Felodipine