title: Underestimation of 24-hour hypotensive efficacy of nifedipine GITS versus enalapril: ambulatory recording as an adjunct to clinical blood pressure measurement.
abstract: OBJECTIVE
  Short-acting calcium entry blockers should be used primarily in slow-release form. Furthermore, studies of the antihypertensive efficacy of drugs can be negatively influenced by between 15% and 30% of the enrolled patients not being hypertensive according to ambulatory blood pressure (BP) measurement. Thus, a randomized double-blind multicenter parallel-group study was conducted to compare the effect of nifedipine GITS (gastrointestinal therapeutic system) with enalapril.
  
  
  RESULTS
  After a 2-week placebo run-in period, 186 patients with a sitting diastolic BP > or = 95 mmHg were enrolled for an 8-week treatment period. They received 30-60 mg nifedipine GITS or 5-10 mg enalapril. Diastolic BP fell comparably from 99 to 87 mmHg (p < 0.01) in the nifedipine GITS group, and from 100 to 88 mmHg (p < 0.01) in the enalapril group. The increase in BP 2 h before waking, however, was suppressed significantly more by nifedipine. Furthermore, this study highlighted the existence of "whitecoat" hypertension in a number of patients, especially when clinical BP was used to identify hypertension. Of the patients who had been identified as hypertensive before randomization by standardized BP measurement, 53 (28.5%) were identified as non-hypertensives by 24-h BP monitoring. This led to an underestimation of the efficacy of the antihypertensive therapy.
  
  
  CONCLUSIONS
  Nifedipine GITS as well as enalapril are comparably effective antihypertensive drugs.
authors.affiliation: Vascular Center, Berlin, Department of Internal Medicine, Ev. Krankenhaus Königin Elisabeth, Academic Teaching Hospital of the Humboldt University (Charité), Germany. k.schulte@keh-berlin.de
authors.forename: K L
authors.initials: KL
authors.lastname: Schulte
authors.forename: T
authors.initials: T
authors.lastname: Lenz
authors.forename: M
authors.initials: M
authors.lastname: Fischer
authors.forename: W
authors.initials: W
authors.lastname: Meyer-Sabellek
authors.forename: R
authors.initials: R
authors.lastname: Gotzen
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination; D004311:Double-Blind Method; D004656:Enalapril / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D004656:Enalapril; D009543:Nifedipine