Comparison of nitrendipine with propranolol and its use in combined cardiovascular therapy

New antihypertensive agents with favorable hemodynamic and metabolic profiles have resulted in reappraisal of traditional step-care therapy using diuretics and beta blockers. Calcium channel blockers are among the new antihypertensive agents that offer better hemodynamic effect compared with beta blockers, and they do not have unwanted metabolic effects as do diuretics. Calcium channel blockers, such as nitrendipine, are effective as monotherapy and in combination with other antihypertensive agents, and are particularly useful in elderly, black and low-renin patients. Preliminary results from a multicenter, double-blind, randomized, parallel study comparing nitrendipine with propranolol in patients over 40 demonstrate similar blood pressure-lowering effectiveness; however, propranolol was associated with a higher incidence of side effects and study withdrawals. In a second study, addition of propranolol to nitrendipine monotherapy produced a further decrease in blood pressure that was sustained over the year of study. These data suggest that nitrendipine provides additional effective and safe antihypertensive therapy, which can be used in place of or in combination with beta blockers.