Abstract

As the number of antihypertensive agents increases, the choice of optimal therapy becomes more difficult. Certainly, hemodynamic derangements caused by the disease state as well as therapy must be considered. Patient convenience and quality of life are also issues that must be addressed. Preliminary experience suggests that the gastrointestinal therapeutic system (GITS) push-pull osmotic pump formulation of nifedipine is safe and efficacious in the treatment of hypertension. In 1 study, nifedipine GITS was compared with sustained-release propranolol in patients with mild to moderate hypertension already receiving diuretics. Using a 2-week placebo run-in, double-blind study design, patients were randomly assigned to receive nifedipine GITS (n = 31) in doses of 30, 60 or 90 mg once daily, or sustained-release propranolol (n = 32) in doses of 80, 160 or 240 mg once daily. Previous diuretic therapy was continued. Sitting and 5-minute standing blood pressure and heart rate measurements were obtained 24 hours after dosing. At the end point of treatment, both nifedipine GITS and sustained-release propranolol reduced blood pressure compared with placebo (p < 0.001) in the sitting and standing positions. Nifedipine GITS was more effective than sustained-release propranolol in reducing standing (p < 0.005) and sitting (p < 0.001) systolic blood pressure and sitting diastolic blood pressure (p < 0.02). Sustained-release propranolol caused a greater reduction in standing (p < 0.001) and sitting (p < 0.0006) resting heart rate than nifedipine GITS. Both drugs were well tolerated. Nifedipine GITS is an effective and safe once-daily drug for use in patients with hypertension already receiving diuretics, and may be more effective than sustained-release propranolol and better tolerated than conventional nifedipine capsule treatment.

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