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Individual responses to converting enzyme inhibitors and calcium antagonists
J Bidiville1, J Nussberger, G Waeber
1Hypertension Division, Centre Hospitalier Universitaire, Lausanne, Switzerland.
Insights
The acute blood pressure response to calcium antagonists or ACE inhibitors does not predict long-term effectiveness in hypertensive patients. Both drug classes showed similar long-term efficacy, and responses were not mutually exclusive.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Management
Background:
- Predicting antihypertensive drug efficacy is crucial for personalized treatment.
- Calcium antagonists and ACE inhibitors are common first-line therapies for hypertension.
- The relationship between acute and long-term drug responses requires further investigation.
Purpose of the Study:
- To determine if acute blood pressure response predicts long-term efficacy of calcium antagonists and ACE inhibitors.
- To investigate if positive responses to these drug classes are mutually exclusive.
Main Methods:
- A randomized crossover trial involving 16 hypertensive patients.
- Patients received enalapril (ACE inhibitor) and diltiazem (calcium antagonist) for 6 weeks each.
- Ambulatory blood pressure monitoring was used, with acute drug effects assessed during a washout phase.
Main Results:
- Acute administration of nifedipine and enalaprilat demonstrated equal blood pressure reduction.
- Long-term treatment with enalapril and diltiazem yielded similar blood pressure reductions.
- Acute response did not reliably predict long-term outcomes for either drug class.
- No age-related differences in antihypertensive effects were observed.
- No evidence suggested that a good response to one drug precluded a good response to the other.
Conclusions:
- Acute blood pressure response is not a reliable predictor of long-term antihypertensive efficacy for ACE inhibitors or calcium antagonists.
- Both ACE inhibitors and calcium antagonists can be effective long-term therapies, and responses are not mutually exclusive.
- Individualized patient responses to these drug classes may vary, necessitating careful long-term monitoring.
Abstract:
This study was designed to assess whether the acute blood pressure response of an individual hypertensive patient to a calcium antagonist or an angiotensin converting enzyme (ACE) inhibitor is a good predictor of the long-term efficacy of these drug classes in this particular patient. The concept that good responses to ACE inhibitors and calcium antagonists may be mutually exclusive was also tested. Sixteen patients were included in a randomized crossover trial of enalapril, 20 mg daily, and diltiazem, 120 mg daily, for 6 weeks each. Blood pressure was measured by ambulatory blood pressure recording. During the washout phase, the acute effect of nifedipine, 10 mg p.o., and enalaprilat, 5 mg i.v., was evaluated. Nifedipine and enalaprilat reduced blood pressure equally well. The long-term blood pressure reduction induced by enalapril and diltiazem was similar. The acute blood pressure response to a given drug was not a good predictor of the result obtained with long-term therapy. No age dependency of the antihypertensive effect of either drug class was apparent. There was no evidence that a good response to one drug excluded a similarly good response to the other.