Individual responses to converting enzyme inhibitors and calcium antagonists.

Abstract

This study was designed to assess whether the acute blood pressure response of an individual hypertensive patient to a calcium antagonist or an angiotensin converting enzyme (ACE) inhibitor is a good predictor of the long-term efficacy of these drug classes in this particular patient. The concept that good responses to ACE inhibitors and calcium antagonists may be mutually exclusive was also tested. Sixteen patients were included in a randomized crossover trial of enalapril, 20 mg daily, and diltiazem, 120 mg daily, for 6 weeks each. Blood pressure was measured by ambulatory blood pressure recording. During the washout phase, the acute effect of nifedipine, 10 mg p.o., and enalaprilat, 5 mg i.v., was evaluated. Nifedipine and enalaprilat reduced blood pressure equally well. The long-term blood pressure reduction induced by enalapril and diltiazem was similar. The acute blood pressure response to a given drug was not a good predictor of the result obtained with long-term therapy. No age dependency of the antihypertensive effect of either drug class was apparent. There was no evidence that a good response to one drug excluded a similarly good response to the other.

Individualization of antihypertensive therapy.

“…Thus, the in vivo functional data of our study 1 and the in vitro radioligand binding data of Oparil and colleagues 2 ' 3 are complementary. Together, these studies point to the conclusion that high dietary sodium intake increases the responsiveness or sensitivity (defined functionally in vivo and biochemically in vitro) of central nervous system a 2 -adrenergic receptor control of renal sympathetic nerve activity and urinary sodium excretion.…”

“…AUTHORS' RESPONSE Our study 1 indicated that high dietary sodium intake increases the responsiveness of the central nervous system a 2 -adrenergic receptor control of renal sympathetic nerve activity and urinary sodium excretion in conscious spontaneously hypertensive rats (SHR). This conclusion was based in part on the findings that 1) for a given intracerebroventricular (i.c.v.)…”

Relationship between Polymorphism of the Angiotensin-Converting Enzyme Gene and the Response to Angiotensin-Converting Enzyme Inhibition in Hypertensive Patients

“…The response of patients to antihypertensive therapy is variable (1). It has long been suspected that interindividual variation in the efficacy and side-effects of medications may be influenced by genetic factors (2).…”

Antihypertensive effects of nitrendipine and cilazapril alone, and in combination in hypertensive patients with chronic renal failure.

“…However, this concept of a mutually exclusive action has been poorly substantiated (Bidiville et al, 1988). Since in hypertensive patients levels of PRA are not found to be distributed as clearly discernible clusters (Laragh, 1985;Buhler et al, 1985) a large group of patients remains, in which there is no clear indication which kind of drug is likely to be more efficacious (Bidiville et al, 1988).…”

“…However, this concept of a mutually exclusive action has been poorly substantiated (Bidiville et al, 1988). Since in hypertensive patients levels of PRA are not found to be distributed as clearly discernible clusters (Laragh, 1985;Buhler et al, 1985) a large group of patients remains, in which there is no clear indication which kind of drug is likely to be more efficacious (Bidiville et al, 1988). Moreover, these drugs have been demonstrated to complement each other in antihypertensive efficacy (Guazzi et al, 1984;Brouwer et al, 1985;MacGregor et al, 1985;Lang et al, 1987;Salvetti et al, 1987).…”