Cardiovascular Reactivity to Physical and Psychologic Stress During Long-Term Treatment with Nitrendipine in Essential Hypertension

Abstract

Nitrendipine is a second-generation dihydropyridine calcium antagonist selective for hypertension. The aim of this study was to assess whether, in addition to reduce resting blood pressure, nitrendipine also affects the cardiovascular reactivity to physical and psychologic stress. Ten essential hypertensive patients, out of treatment for at least 2 weeks, underwent a symptom-limited dynamic maximal exercise and a mental arithmetic stress test (MAT) after placebo (1 week) and 1 and 5 weeks of active treatment with nitrendipine (20 mg q.i.d.). To evaluate the cardiovascular response to exercise and its changes during treatment, the slope of the regression line (if statistically significant) of the blood pressure, heart rate, and rate-pressure product (RPP) values against workload were considered, together with exercise capacity, blood pressure, and pressure-rate product at the peak of maximal exercise. During mental stress, indexes of stroke volume (SVI), cardiac output (COI), and peripheral resistance (TPRI) were obtained by Doppler transcutaneous aortovelography (TAV). Resting systolic and diastolic BP were significantly reduced during treatment. The average length of exercise was 7.3, 7.64, and 8.0 min after, respectively, placebo, 1, and 5 weeks of treatment. Peak systolic and diastolic BP, peak RPP, and RPP slope were consistently decreased after treatment, significantly for peak DBP and RPP. During mental arithmetics, a significant increase of BP and HR and a decrease of SVI were observed on placebo; both BP and SVI responses disappeared after 5 weeks on nitrendipine, whereas the HR increase was unchanged. Peak values of COI and TPRI during MAT were significantly increased and decreased, respectively, after nitrendipine, whereas basal values showed similar changes, but not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)