Effects of chronic nitrendipine on casual (office) and 24-hour ambulatory blood pressure

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Abstract
To assess the clinical efficacy of chronic nitrendipine therapy in mild to moderate essential hypertension, blood pressure (BP) and heart rate responses were studied in 22 subjects receiving maintenance nitrendipine therapy. Ten subjects (45%) whose hypertension was controlled with chronic monotherapy had an 11/12 mm Hg decrease in supine BP (P < 0.05) with a mean (.+-. SD) dose of 71 .+-. 15 mg/day. The 12 (55%) subjects whose hypertension was not controlled with monotherapy had a comparatively higher baseline BP than the other 10 (156/105 .+-. 10/6 compared with 150/98 .+-. 15/4 mm Hg; P < 0.05). Eight of the 10 subjects demonstrating office BP control with chronic nitrendipine monotherapy who also had full-time employment underwent continuous ambulatory BP monitoring before and after maintenance monotherapy. Nitrendipine induced a reduction in the mean 24-h BP and mean BP at home, but did not reduce the BP during work or while asleep. Nitrendipine lowers BP when assessed by casual office methods. The ambulatory BP monitor data demonstrate that the hypotensive response to chronic nitrendipine is modified during work periods, which are generally associated with increased adrenergic activity. Ambulatory BP monitoring may be superior to office (casual) monitoring in the assessment of the overall efficacy of antihypertensive drugs.

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