Effect of pindolol and nifedipine alone and in combination on haemodynamic parameters/variables in essential...

Thirteen patients with essential hypertension were started on pindolol 10-20 mg daily and twelve on nifedipine 20-60 mg daily. At the end of 6 weeks inadequate responders (B.P. greater than 140/90) were put onto combined treatment with both drugs, ten of the pindolol and six of the nifedipine patients being affected. Combined therapy then continued for a further 6-week period, while adequate responders (B.P. less than 140/90) continued with their initial drug. In addition to blood pressure, heart rate and cardiac index were also measured, and total peripheral resistance index was calculated. Where blood pressure decreased below 140/90 at the end of 12 weeks in patients on combined treatment, the original drug was withdrawn, leaving the patient on a single-drug regimen again, this time with the 'second compound'. This manoeuvre was followed by a rise in blood pressure in five out of eight patients in whom pindolol was withdrawn and in two out of six after nifedipine withdrawal. No definite conclusions can be drawn from these findings, and it may be that a better approach to the problem of poor responders would be to try each drug on its own before combining them, rather than combining first and then withdrawing the initial treatment. The increased peripheral resistance typical of essential hypertension was not adversely affected by either drug, while combined treatment had a beneficial effect on this parameter.