Skip to main content
British Journal of Clinical Pharmacology logoLink to British Journal of Clinical Pharmacology
. 1993 Oct;36(4):323–330. doi: 10.1111/j.1365-2125.1993.tb00371.x

The antihypertensive efficacy and tolerability of a low dose combination of ramipril and felodipine ER in mild to moderate essential hypertension.

A D Bainbridge 1, R J Macfadyen 1, S Stark 1, K R Lees 1, J L Reid 1
PMCID: PMC1364685  PMID: 12959310

Abstract

1. The antihypertensive efficacy and tolerability of a low dose combination of the angiotensin converting enzyme inhibitor ramipril (2.5 mg) and the extended release formulation of the dihydropyridine calcium channel antagonist felodipine (5 mg) were assessed in a double-blind, double dummy placebo controlled, randomised, crossover study in 20 patients (mean age 55.4 years; range 46-69) with uncomplicated mild to moderate hypertension (supine diastolic > 90 mmHg < 115 mmHg after 4 weeks of single-blind wash-out on placebo). The four randomised, double-blind, crossover study phases evaluated the response to 4 weeks of once daily treatment with placebo, monotherapy with each drug and the combination. Noninvasive ambulatory blood pressure monitoring (Spacelabs 90207) was performed for 24 h at the end of each phase. 2. The mean 24 h ambulatory blood pressure (mmHg) was 147.9/92.0 following placebo, 141.3/87.8 following monotherapy with ramipril 2.5 mg, 136.8/85.8 following monotherapy with felodipine ER 5 mg and 131.1/82.6 following the combination of ramipril 2.5 mg and felodipine ER 5 mg. All active treatment phases significantly reduced mean 24 h ambulatory diastolic pressure by comparison with placebo. The antihypertensive efficacy of the combination was additive. 3. The coadministration of ramipril did not attenuate the incidence of headache attributable to felodipine ER.

Full text

PDF
323

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersson O. K., Hedner T., Granérus G. Felodipine in combination with a beta-blocker and a diuretic in chronic treatment of patients with refractory primary hypertension. Drugs. 1987;34 (Suppl 3):156–160. doi: 10.2165/00003495-198700343-00033. [DOI] [PubMed] [Google Scholar]
  2. Bainbridge A. D., MacFadyen R. J., Lees K. R., Reid J. L. A study of the acute pharmacodynamic interaction of ramipril and felodipine in normotensive subjects. Br J Clin Pharmacol. 1991 Feb;31(2):148–153. doi: 10.1111/j.1365-2125.1991.tb05503.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bossini A., Di Veroli C., Cavallotti G., Cagli V. Felodipine ER formulation in the treatment of mild hypertension: efficacy and tolerability vs placebo. Br J Clin Pharmacol. 1990 Oct;30(4):567–571. doi: 10.1111/j.1365-2125.1990.tb03814.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Brouwer R. M., Bolli P., Erné P., Conen D., Kiowski W., Bühler F. R. Antihypertensive treatment using calcium antagonists in combination with captopril rather than diuretics. J Cardiovasc Pharmacol. 1985;7 (Suppl 1):S88–S91. doi: 10.1097/00005344-198507001-00017. [DOI] [PubMed] [Google Scholar]
  5. Campbell B. C., Sturani A., Reid J. L. Evidence of parasympathetic activity of the angiotensin converting enzyme inhibitor, captopril, in normotensive man. Clin Sci (Lond) 1985 Jan;68(1):49–56. doi: 10.1042/cs0680049. [DOI] [PubMed] [Google Scholar]
  6. Carle W. K., Latta D., Lees C. T., Lough J. R., Pender J., Ross J. R., Sefton S., Peers E. M., Richardson P. D. A comparison of felodipine and propranolol as additions to hydrochlorothiazide in the treatment of hypertension. Eur J Clin Pharmacol. 1988;34(2):115–118. doi: 10.1007/BF00614545. [DOI] [PubMed] [Google Scholar]
  7. Chiknas S. G. A liquid chromatography-assisted assay for angiotensin-converting enzyme (peptidyl dipeptidase) in serum. Clin Chem. 1979 Jul;25(7):1259–1262. [PubMed] [Google Scholar]
  8. Coats A. J. Reproducibility or variability of casual and ambulatory blood pressure data: implications for clinical trials. J Hypertens Suppl. 1990 Dec;8(6):S17–S20. [PubMed] [Google Scholar]
  9. Donnelly R., Elliott H. L., Meredith P. A., Reid J. L. An evaluation of the pharmacodynamics and pharmacokinetics of nicardipine combined with enalapril in essential hypertension. J Cardiovasc Pharmacol. 1987 Dec;10(6):723–727. doi: 10.1097/00005344-198712000-00017. [DOI] [PubMed] [Google Scholar]
  10. Groppelli A., Omboni S., Ravogli A., Villani A., Parati G., Mancia G. Validation of the SpaceLabs 90202 and 90207 devices for ambulatory blood pressure monitoring by comparison with intra-arterial resting and ambulatory measurements. J Hypertens Suppl. 1991 Dec;9(6):S334–S335. [PubMed] [Google Scholar]
  11. Guazzi M. D., De Cesare N., Galli C., Salvioni A., Tramontana C., Tamborini G., Bartorelli A. Calcium-channel blockade with nifedipine and angiotensin converting-enzyme inhibition with captopril in the therapy of patients with severe primary hypertension. Circulation. 1984 Aug;70(2):279–284. doi: 10.1161/01.cir.70.2.279. [DOI] [PubMed] [Google Scholar]
  12. Heber M. E., Brigden G. S., Caruana M. P., Lahiri A., Raftery E. B. First dose response and 24-hour antihypertensive efficacy of the new once-daily angiotensin converting enzyme inhibitor, ramipril. Am J Cardiol. 1988 Aug 1;62(4):239–245. doi: 10.1016/0002-9149(88)90219-6. [DOI] [PubMed] [Google Scholar]
  13. Liedholm H., Melander A. A placebo-controlled dose-response study of felodipine extended release in hypertensive patients. J Cardiovasc Pharmacol. 1989 Jul;14(1):109–113. doi: 10.1097/00005344-198907000-00019. [DOI] [PubMed] [Google Scholar]
  14. Morgan T., Anderson A., Hopper J. Enalapril & nifedipine in essential hypertension; synergism of the hypotensive effects in combination. Clin Exp Hypertens A. 1988;10(5):779–789. doi: 10.1080/07300077.1988.11878784. [DOI] [PubMed] [Google Scholar]
  15. Müller F. B., Bolli P., Linder L., Kiowski W., Erne P., Bühler F. R. Calcium antagonists and the second drug for hypertensive therapy. Am J Med. 1986 Dec 15;81(6A):25–29. doi: 10.1016/0002-9343(86)90791-6. [DOI] [PubMed] [Google Scholar]
  16. Nelson R. R., Gobel F. L., Jorgensen C. R., Wang K., Wang Y., Taylor H. L. Hemodynamic predictors of myocardial oxygen consumption during static and dynamic exercise. Circulation. 1974 Dec;50(6):1179–1189. doi: 10.1161/01.cir.50.6.1179. [DOI] [PubMed] [Google Scholar]
  17. O'Brien E., O'Malley K. Twenty-four-hour ambulatory blood pressure monitoring: a review of validation data. J Hypertens Suppl. 1990 Dec;8(6):S11–S16. [PubMed] [Google Scholar]
  18. Reid J. L., Bainbridge A. D., MacFadyen R. J. The contribution of ambulatory blood pressure measurement to the evaluation of new antihypertensive drugs. J Hypertens Suppl. 1991 Dec;9(8):S54–S56. [PubMed] [Google Scholar]
  19. Smith S. A., Mace P. J., Littler W. A. Felodipine, blood pressure, and cardiovascular reflexes in hypertensive humans. Hypertension. 1986 Dec;8(12):1172–1178. doi: 10.1161/01.hyp.8.12.1172. [DOI] [PubMed] [Google Scholar]
  20. Zabludowski J., Rosenfeld J., Akbary M. A., Rangoonwala B., Schinzel S. A multi-centre comparative study between ramipril and enalapril in patients with mild to moderate essential hypertension. Curr Med Res Opin. 1988;11(2):93–106. doi: 10.1185/03007998809110452. [DOI] [PubMed] [Google Scholar]
  21. Zacest R., Gilmore E., Koch-Weser J. Treatment of essential hypertension with combined vasodilation and beta-adrenergic blockade. N Engl J Med. 1972 Mar 23;286(12):617–622. doi: 10.1056/NEJM197203232861201. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Clinical Pharmacology are provided here courtesy of British Pharmacological Society

RESOURCES