Randomized trial comparing the effects of a low-dose combination of nifedipine GITS and valsartan versus high-dose monotherapy on central hemodynamics in patients with inadequately controlled hypertension

Abstract

A low-dose combination of nifedipine GITS plus valsartan or high-dose nifedipine was more effective in improving central hemodynamics than high-dose valsartan in patients with hypertension, mostly because of the improvement in peripheral (brachial) hemodynamics.

Effect of Continuous Positive Airway Pressure on Cardiovascular Biomarkers

“…41 The magnitude of CPAP effect on morning AIx (À6.49 [À9.32 to À3.65]) is within range of antihypertensive medication effect (5.4 AE 2.5 reduction). 42 Our findings confirm interventional trial data involving smaller samples that demonstrated improvement in AIx. 43,44 In contrast, use of CPAP in those with OSA without history of CVD or minimally symptomatic OSA did not result in significant reductions of AIx.…”

Magnitude of and Characteristics Associated With the Treatment of Calcium Channel Blocker–Induced Lower-Extremity Edema With Loop Diuretics

“…We performed stratified analyses among subpopulations based on age (ie, <65 and Ն65 years) because older adults may be more likely to experience a prescribing cascade because of polypharmacy, increased complexity of clinical management of multiple chronic conditions, and increased susceptibility to adverse events 29 ; sex because women are more likely to report edema 13,22,43 ; initial DH CCB type (ie, amlodipine, isradipine, nifedipine, or felodipine) because amlodipine is associated with an increased risk of edema 10 ; initial DH CCB dose (ie, low, standard, or high) (eTable 2 in the Supplement) because risk of DH CCB-induced edema increases with higher doses 11,12,[44][45][46][47] ; and number of unique antihypertensive medication classes used within 1 year before DH CCB initiation because a loop diuretic may be used if multiple antihypertensive medication classes have failed to control hypertension. 48…”

Safety of the Up-titration of Nifedipine GITS and Valsartan or Low-dose Combination in Uncontrolled Hypertension: the FOCUS Study

“…This prospective, open-label, randomized, activecontrolled 8-week study explored the safety and efficacy of up-titration of nifedipine GITS versus up-titration of valsartan monotherapy. In addition to the previous FOCUS study that reported an increasing average central and peripheral BP reduction by doubling the dose of nifedipine GITS, 6 the present study is the first to focus on safety by using a stepwise uptitration of nifedipine GITS and BP variability, known to be an independent predictor of cardiovascular mortality. The main findings of the study, compared with up-titration of the ARB valsartan, are as follows:…”

“…[3][4][5] In practice, however, only a few studies have compared the antihypertensive effects and adverse effects of switching angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) from low to high doses; these agents are recommended as primary drugs in most of the guidelines. [6][7][8] In addition, only a few studies have compared the antihypertensive effects and adverse effects of high doses of a single drug versus combination therapy. 9,10 The previous FOCUS study 6 found that, compared with the combination of a high-dose nifedipine gastrointestinal therapeutic system (GITS) and valsartan, the low-dose combination of nifedipine GITS plus valsartan or high-dose nifedipine was more effective in improving peripheral (brachial) hemodynamics, thereby lowering central and peripheral blood pressure (BP).…”

“…[6][7][8] In addition, only a few studies have compared the antihypertensive effects and adverse effects of high doses of a single drug versus combination therapy. 9,10 The previous FOCUS study 6 found that, compared with the combination of a high-dose nifedipine gastrointestinal therapeutic system (GITS) and valsartan, the low-dose combination of nifedipine GITS plus valsartan or high-dose nifedipine was more effective in improving peripheral (brachial) hemodynamics, thereby lowering central and peripheral blood pressure (BP). However, few studies have shown the effects of the low-dose combination on BP variability; this variability is known to be related to cardiovascular morbidity and mortality, independent from mean BP and frequency of adverse effects caused by powerful BP reductions produced by step-by-step increases in dose.…”