Treatment of severe hypertensives: double blind comparison on cardiac haemodynamics of ace-inhibition + $beta;-blocker vs ace-inhibition + CA-antagonist. Rest and effort evaluation.
S DISOMMA · American Journal of Hypertension · 1995
We evaluated the antihypertensive and hemodynamic effects at rest and during exercise test of ACE-inhibitor alone or combined to a beta-blocker or a Ca channel blocker in severe hypertensive patients. After a two week placebo (PL) period, 19 hypertensive patients (mean age 48 ± 2 years) received perindopril (P) 8 mg o.d. for one month. If their supine DBP remained ≥95 mmHg, atenolol (A) 100 mg o.d. or nitrendipine (N) 20 mg o.d. were (double blind cross-over study) associated for one month treatment. Hemodynamic parameters were measured using electrical bioimpedance (Bo Med, NCCOM2) at rest and during a submaximal supine cycloergometer stress test. The following results were obtained either with P 8 mg or in association with A or N: SV = Stroke volume; SVR = Systemic Vascular Resistance; Aortic stiffness = Pulse Pressure/SV; * = p < 0.01 P vs PL; * p < 0.01 PA + A or P + N vs P. SV = Stroke volume; SVR = Systemic Vascular Resistance; Aortic stiffness = Pulse Pressure/SV; * = p < 0.01 P vs PL; * p < 0.01 PA + A or P + N vs P. Perindopril 8 mg o.d. is effective in lowering BP at rest and during exercise in severe hypertensives. Its antihypertensive effect is associated with a reduction in SVR and an improvement in left ventricular function and aortic stiffness. In patients not normalized by monotherapy the addition of either A 100 mg or N 20 mg to P 8 mg causes a similar and further decrease in both SBP and DBP. The combination with beta-blocker, compared to that with Ca channel blocker, gives a better haemodynamic pattern (systolic function and aortic stiffness).