The antihypertensive efficacy of nifedipine alone and in combination in general practice

A multi-centre study in general practice involving 3242 hypertensive patients, aged up to 70 years, was carried out to evaluate the efficacy and tolerability of nifedipine used alone or in combination with other antihypertensive agents in step-care treatment. Patients were treated for up to 8 weeks with one of four regimens: nifedipine monotherapy; diuretic and nifedipine; beta-blocker plus nifedipine; and nifedipine added to a combination of diuretic and beta-blocker. All patients received 20 mg nifedipine, in slow-release tablet form, twice daily; at Week 4, dosage was increased to 40 mg twice daily in 8.5% patients because their supine diastolic blood pressure still exceeded 95 mmHg. Changes in mean blood pressure of the total study group for systolic and diastolic, supine and standing, were highly significant both from baseline (Week 0) to Week 4 (p less than 0.0001) and from baseline to Week 8 (p less than 0.0001). Mean blood pressure reduction was 29/18 mmHg supine and 27/18 mmHg standing. Statistical differences in blood pressure response between age, sex and treatment groups were not of clinical significance. Statistically significant reductions in heart rate (mean 1.9 beats/min, p less than 0.001) and body weight (mean 0.48 kg, p less than 0.001) were noted, but were not of clinical relevance. Nifedipine produced a net increase of 12% in side-effects at Week 4 compared to the profile at entry.