Felodipine Compared to Nifedipine as "Third-Line Drug" in Resistant Hypertension

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Abstract
Felodipine is a new dihydropyridine calcium antagonist, and in hypertension it is a much more effective "third-line" drug than hydralazine. Nifedipine, on the other hand, is the established dihydropyridine calcium antagonist that has been increasingly used to treat hypertension. Information is now needed on the relative merits and demerits of these two drugs. This study appraised, there fore, the therapeutic utility of twelve months' treatment with nifedipine 20-60 mg twice daily in 55 patients with previous drug-resistant hypertension who had been successfully treated for the previous year with felodipine 5-20 mg twice daily, each calcium antagonist being used in combination with atenolol 100 mg daily with or without chlorthalidone 25 mg daily. Initially, nifedipine main tained comparable blood pressure control to that which had been achieved by felodipine, although in the longer term (over eight months) nifedipine proved less effective than felodipine had (p < 0.02) and more patients became uncon trolled (supine diastolic blood pressure, Phase V, ≥90 mmHg) on the maximum tolerated dose of the calcium antagonist (χ2=4.13, p < 0.05 > 0.025). The former degree of blood pressure control was, however, reestablished by increas ing the dose of nifedipine or reintroducing the diuretic as necessary, and this control was maintained over the next four months. Minor side efects were less common on nifedipine than they had been during the preceding felodipine treatment phase. Felodipine thus has more pronounced and sustained antihypertensive effects than nifedipine, though its side effect burden may appear to be greater. Because of possible treatment order effects and the development of tolerance to dihydro pyridine side effects, formal comparison of these two compounds is warranted.