Cardiac and hemodynamic adjustments to rapid and sustained blood pressure reduction

The most effective strategies for achieving immediate and long-term control of blood pressure and reversal of left ventricular (LV) hypertrophy and dysfunction in severe hypertensives is not known. In this preliminary communication, we report our experience with long-term blood pressure control in severe hypertensives who were treated with up to 150 mg of nifedipine gastrointestinal therapeutic system (GITS)--a once daily nifedipine formulation. In 23 subjects with diastolic blood pressures greater than 120 mm Hg, treatment was begun with nifedipine capsules for immediate reduction of diastolic blood pressure to less than 110 mm Hg. Doppler echocardiography was used to measure LV mass, percent LV fractional shortening (%FS), and cardiac output (CO). To achieve a goal diastolic blood pressure of less than 95 mm Hg, the 22 subjects who responded to nifedipine capsules were titrated up to 150 mg of nifedipine GITS. To date, 12 subjects completed two months of goal blood pressure with nifedipine GITS. CO, heart rate (HR), and %FS were elevated following nifedipine capsules. During long-term therapy with nifedipine GITS, CO and HR returned to baseline, while %FS remained elevated. These preliminary data suggest that in patients with severe hypertension, effective long-term control of BP with a once-a-day dosage of nifedipine in the GITS formulation may be achieved without adverse hemodynamic effects.