Acute effects of increasing doses of urapidil in patients with hypertension

In a randomized, double-blind, dose-ranging trial, the acute antihypertensive effects of 7.5, 15, 30, 45, 60, 90, and 120 mg single daily doses of urapidil were compared with those of placebo in 10 patients with essential hypertension. Patients were randomized to either urapidil or placebo, such that each active drug day was followed by a placebo washout day. Blood pressure and heart rate responses were measured in the supine position, immediately upon standing, and after 3 to 5 minutes of standing for each dose. A variable but significant reduction in systolic and diastolic blood pressures that lasted from 4.5 to 8 hours was observed primarily at the 60, 90, and 120 mg doses (P less than 0.05). The maximum reduction in diastolic blood pressure occurred in the standing position at 3 to 5 hours after dosing. When urapidil was compared with placebo, a change from the supine to the standing positions produced a significantly larger reduction in systolic and diastolic blood pressures (P less than 0.05) but no significant change in heart rate. This suggests an acute blood pressure lowering effect of urapidil that occurs predominantly in the standing position and that does not significantly increase heart rate.