A Comparison of the Effects of Nifedipine and Verapamil on Exercise Performance in Patients With Mild to Moderate Hypertension

Abstract

Twenty-four patients completed a double-blind, randomized clinical trial comparing the effects of nifedipine GITS (N) and verapamil SR (V) on blood pressure (BP) control and exercise performance. After a 2-week placebo phase, all subjects had measurements of VO2max, maximal workload, and endurance time. They were then randomized to either N (30 to 90 mg/day) or V (240 to 480 mg/day) and retested when BPs had stabilized. At rest, N lowered systolic (S) BP by 12 mm Hg (P = .02 compared to baseline) and diastolic (D) BP by 11 mm Hg (P = .001). V lowered SBP by 8 mm Hg (P = .013) and DBP by 11 mm Hg (P = .002). Neither drug affected resting heart rate. V significantly decreased resting epinephrine (P = .05) and there was a tendency for V to reduce norepinephrine (P = .07) and dopamine (P = .08). N tended to increase plasma renin activity (P = .07). During graded cycle ergometry N, compared with placebo, significantly lowered DBP at all exercise levels (P = .011), but had no significant effect on heart rate (HR), SBP, or heart rate pressure product (HRPP). Pulse pressure (PP) was significantly increased (P = .045), which was most noticeable at high exercise levels. Compared with placebo, V caused a marked reduction of exercise HR (P < .001), which was more pronounced at high levels, SBP (P = .004), DBP (P = .004), mean arterial pressure (MAP) (P = .001), and HRPP (P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of diastolic dysfunction in hypertensive patients without left ventricular hypertrophy

“…Thus, diastolic dysfunction was determined mainly by dynamic factors, being that the role of structural factors is insignificant. Concerning BP control, our results coincide with other reports [19][20][21][22][23][24][25][26] and both treatments efficiently controlled BP both at short-and long-term. Blood pressure reduction produced a decrease in afterload, which in turn could explain the reduction in ventricular stress seen with both therapies.…”

I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica

“…Esses hipotensores são bastante eficazes em reduzir a pressão arterial e não provocam alterações no metabolismo lipídico e no de carboidratos 112,113 . Isto se aplica tanto aos diidropiridínicos quanto aos não-diidropiridínicos, embora seus efeitos em longo prazo em relação à progressão da nefropatia diabética ainda não tenham sido determinados.…”

Choice of drug treatment for obesity-related hypertension: where is the evidence?

“…This drug has been shown to decrease heart rate ± a potentially bene®cial effect in obese individuals when one wishes to avoid the use of a â-blocker [47]. Furthermore, in contrast to dihydropyridine calcium-channel blockers, verapamil does not produce re¯ex activation [48] or may even inhibit sympathetic activity [47,49]. In addition, verapamil may reverse the hyper®ltration and microalbuminuria [50] that are often seen in patients with the metabolic syndrome [16].…”