Skip to main content
NCBI home page
British Journal of Clinical Pharmacology logoLink to British Journal of Clinical Pharmacology
. 1990 Apr;29(4):455–463. doi: 10.1111/j.1365-2125.1990.tb03664.x

Comparison of once daily atenolol, nitrendipine and their combination in mild to moderate essential hypertension.

D Maclean 1, E T Mitchell 1, R Lewis 1, N Irvine 1, J S McLay 1, J McEwen 1, R R Coulson 1, N D Slater 1, T J Fitzsimons 1, D G McDevitt 1
PMCID: PMC1380116  PMID: 2183868

Abstract

1. The aim of the study was to compare the efficacy and the tolerability of treatment with atenolol (50-100 mg once daily), nitrendipine (20-40 mg once daily) and their combination (atenolol 50 mg + nitrendipine 20 mg) once daily in patients with mild to moderate essential hypertension. 2. The study was a randomised, double-blind, placebo controlled parallel groups design: blood pressures were measured at 'trough' effect (i.e. 24 h after dosing) to assess the adequacy of once-daily treatment. 3. Mean blood pressures (mm Hg) recorded on four occasions over 12 weeks of treatment were significantly lower both with atenolol (155/97 sitting: 155/104 standing) and with the combination of atenolol plus nitrendipine (153/96 sitting: 152/104 standing) than with placebo (169/108 sitting: 169/114 standing). Nitrendipine alone had no significant effect on blood pressure 24 h after dosing (165/104 sitting: 165/110 standing). 4. Withdrawals due to adverse effects were more common during treatment with nitrendipine: 7/32 of the patients experienced adverse effects attributable to intense systemic vasodilatation (e.g., flushing, erythema, headache). 2/37 patients taking atenolol were withdrawn: one because he developed a psoriatic rash and the other because of impaired peripheral circulation. Of the 35 patients taking combination treatment, two were withdrawn: one developed headaches and dyspnoea, and the other asthma. 5. The results suggest that once daily dosing with nitrendipine does not control blood pressure throughout the 24 h period in the majority of patients, and is associated with a considerable burden of adverse effects. Combination treatment was better tolerated but appeared to offer no advantages over atenolol alone in terms either of blood pressure control or adverse effects.

Full text

PDF
455

Selected References

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

  1. Abel E. A., DiCicco L. M., Orenberg E. K., Fraki J. E., Farber E. M. Drugs in exacerbation of psoriasis. J Am Acad Dermatol. 1986 Nov;15(5 Pt 1):1007–1022. doi: 10.1016/s0190-9622(86)70265-x. [DOI] [PubMed] [Google Scholar]
  2. Daniels A. R., Opie L. H. Atenolol plus nifedipine for mild to moderate systemic hypertension after fixed doses of either agent alone. Am J Cardiol. 1986 Apr 15;57(11):965–970. doi: 10.1016/0002-9149(86)90740-x. [DOI] [PubMed] [Google Scholar]
  3. Davidson C., Thadani U., Singleton W., Taylor S. H. Comparison of antihypertensive activity of beta-blocking drugs during chronic treatment. Br Med J. 1976 Jul 3;2(6026):7–9. doi: 10.1136/bmj.2.6026.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Goa K. L., Sorkin E. M. Nitrendipine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in the treatment of hypertension. Drugs. 1987 Feb;33(2):123–155. doi: 10.2165/00003495-198733020-00003. [DOI] [PubMed] [Google Scholar]
  5. Heagerty A. M., Swales J. D. A double-blind randomized cross-over study of the efficacy and tolerability of nifedipine and nitrendipine in the treatment of mild to moderate hypertension. Br J Clin Pharmacol. 1989 Apr;27(4):411–416. doi: 10.1111/j.1365-2125.1989.tb05387.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Imataka K., Seki A., Takahashi N., Fujii J., Ohuchi Y., Kuwako K., Umeda T., Machii K., Hasegawa T., Ozoe A. [Elevation of serum creatine phosphokinase during pindolol treatment (author's transl)]. Nihon Naika Gakkai Zasshi. 1981 Apr 10;70(4):580–585. [PubMed] [Google Scholar]
  7. Jain A. K., McMahon F. G., Ryan J. R., Maronde R., Vlachakis N., Mroczek W. Efficacy and safety of nitrendipine in patients with severe hypertension: a multiclinic study. J Cardiovasc Pharmacol. 1984;6 (Suppl 7):S1053–S1059. [PubMed] [Google Scholar]
  8. Katzman P. L., Henningsen N. C., Hulthén U. L. Amiloride compared with nitrendipine in treatment of essential hypertension. J Hum Hypertens. 1988 Oct;2(3):147–151. [PubMed] [Google Scholar]
  9. Lazarus J. H., Littley M. D., Phillips D. I. Efficacy of once daily nitrendipine in essential hypertension--a study using ambulatory blood pressure monitoring. J Hum Hypertens. 1988 Oct;2(3):191–194. [PubMed] [Google Scholar]
  10. Lederballe Pedersen O., Christensen C. K., Mikkelsen E., Rämsch K. D. Relationship between the antihypertensive effect and steady-state plasma concentration of nifedipine given alone or in combination with a beta-adrenoceptor blocking agent. Eur J Clin Pharmacol. 1980 Oct;18(4):287–293. doi: 10.1007/BF00561384. [DOI] [PubMed] [Google Scholar]
  11. Lewis J. G. Adverse reactions to calcium antagonists. Drugs. 1983 Feb;25(2):196–222. doi: 10.2165/00003495-198325020-00006. [DOI] [PubMed] [Google Scholar]
  12. Lund-Johansen P., Omvik P. Haemodynamic effects of nifedipine in essential hypertension at rest and during exercise. J Hypertens. 1983 Aug;1(2):159–163. doi: 10.1097/00004872-198308000-00008. [DOI] [PubMed] [Google Scholar]
  13. Maclean D., Mitchell E. T., Coulson R. R., Fitzsimons T. J., McDevitt D. G. Atenolol-nifedipine combinations compared to atenolol alone in hypertension: efficacy and tolerability. Br J Clin Pharmacol. 1988 Apr;25(4):425–431. doi: 10.1111/j.1365-2125.1988.tb03325.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Murphy M. B., Scriven A. J., Dollery C. T. Role of nifedipine in treatment of hypertension. Br Med J (Clin Res Ed) 1983 Jul 23;287(6387):257–259. doi: 10.1136/bmj.287.6387.257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Müller F. B., Bolli P., Erne P., Kiowski W., Bühler F. R. Use of calcium antagonists as monotherapy in the management of hypertension. Am J Med. 1984 Aug 31;77(2B):11–15. doi: 10.1016/s0002-9343(84)80079-0. [DOI] [PubMed] [Google Scholar]
  16. Savola J., Vehviläinen O., Vätäinen N. Psoriasis as a side effect of beta blockers. Br Med J (Clin Res Ed) 1987 Sep 12;295(6599):637–637. doi: 10.1136/bmj.295.6599.637. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Sorkin E. M., Clissold S. P., Brogden R. N. Nifedipine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy, in ischaemic heart disease, hypertension and related cardiovascular disorders. Drugs. 1985 Sep;30(3):182–274. doi: 10.2165/00003495-198530030-00002. [DOI] [PubMed] [Google Scholar]
  18. Tourkantonis A., Lasaridis A., Settas L. Clinical experience with long-term nitrendipine treatment in essential hypertension. J Cardiovasc Pharmacol. 1984;6 (Suppl 7):S1090–S1095. [PubMed] [Google Scholar]
  19. White W. B., Smith V. E., McCabe E. J., Meeran M. K. Effects of chronic nitrendipine on casual (office) and 24-hour ambulatory blood pressure. Clin Pharmacol Ther. 1985 Jul;38(1):60–64. doi: 10.1038/clpt.1985.135. [DOI] [PubMed] [Google Scholar]
  20. Wikstrand J., Warnold I., Olsson G., Tuomilehto J., Elmfeldt D., Berglund G. Primary prevention with metoprolol in patients with hypertension. Mortality results from the MAPHY study. JAMA. 1988 Apr 1;259(13):1976–1982. [PubMed] [Google Scholar]

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

RESOURCES