Atenolol and Sustained Release Nifedipine Alone and in Combination in Hypertension

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Abstract
In this randomised, double-blind, crossover trial, the efficacy in hypertension of atenolol and nifedipine as single agents or in combination was compared. 81 patients with mild to moderate essential hypertension (sitting diastolic blood pressure 100–120mm Hg, aged 20–70 years) from 6 outpatient clinics entered the study. By use of a Latin-square design, patients received, in randomised fashion, sustained release nifedipine 20mg twice daily, atenolol 50mg in the morning and then placebo in the evening, or sustained release nifedipine 20mg plus atenolol 50mg in the morning and then placebo in the evening. Each schedule was followed for 4 weeks. All treatments lowered systolic and diastolic blood pressure in the supine and standing positions compared with pretreatment values. The combination regimen significantly reduced supine and standing systolic (p < 0.01 and p < 0.001, respectively) and diastolic (p < 0.001) blood pressure compared with nifedipine alone, and it also significantly reduced supine and standing systolic (p < 0.01 and p < 0.03, respectively) and diastolic (p < 0.01) blood pressure compared with atenolol alone. Heart rate was significantly decreased by atenolol and the combination compared with nifedipine alone. 15 patients withdrew because of side effects: 9 during nifedipine treatment, 2 during atenolol treatment and 4 during combination treatment. Side effects were typical of those associated with nifedipine or atenolol. Flushes and hot sweats, which were frequent with nifedipine, were significantly less (p < 0.001) with atenolol or the combination. For selected patients who do not respond to monotherapy with nifedipine or atenolol, the combination regimen seems an appropriate and useful alternative to β-blocker/diuretic combinations, especially where ischaemic heart disease may co-exist.