Ketanserin versus nifedipine in the treatment of essential hypertension in patients over 50 years old: an international multicenter study.

The serotonergic antagonist ketanserin (K) was compared to nifedipine (N) in a five-center international study on hypertensive patients over the age of 50 years. After a 4-week placebo run-in period, patients were randomly assigned to receive for 3 months either ketanserin (40 mg b.i.d. after 2 weeks of 20 mg b.i.d.) or nifedipine (20 mg N retard b.i.d.). After 1 month, monotherapy patients whose blood pressure was not sufficiently reduced received a diuretic in combination therapy. At the end of the active treatment period, patients who had remained on monotherapy received placebo until hypertension returned or for a maximum of 2 months. One hundred and seventeen patients were entered in the study, 58 on K and 59 on N. More patients switched to combination with a diuretic in the K group (14 patients) than in the N group (6 patients). The overall reduction in blood pressure was similar for K and N. Total response rate was high (96%) for the two drugs. Blood pressure was reduced both at peak and trough drug levels. No orthostatic reactions were observed, and no rebound hypertension occurred at discontinuation of therapy. Ketanserin monotherapy slightly decreased heart rate (-1 beats/min). whereas N produced a significant increase (+6 beats/min). Body weight significantly increased with K (+1.1 kg) and was unchanged with N. More patients complained of adverse reactions during N monotherapy (47%) than during K monotherapy (34%). Flushing and leg edema were more frequent with N.

[Acute effect of nifedipine on arterial pressure and the renin-angiotensin system in healthy subjects and hypertensives]. / Effet aigu de la nifédipine sur la pression artérielle et le système rénine-angiotensine chez l'homme normal et hypertendu.

The acute effects of nifedipine (20 mg capsules) on the blood pressure and renin-angiotensine system were studied in 108 subjects, 25 normotensives, 51 borderline hypertensives and 33 permanent essential hypertensives. The fall in mean blood pressure (MBP) was rapid (less than 30 minutes) and significant in all groups; the amplitude the hypotensive response expressed as a percentage of the basal MBP was directly related to the basal MBP value (r = 0.54, p less than 0.001). The amplitude of the response correlated with the control plasma renin activity only the group with permanent hypertension (r = - 0.40, p less than 0.025). The fall in blood pressure and the reflex sympathetic stimulation induced by nifedipine were not associated with an increased plasma renin activity. The plasma aldosterone concentrations varied only in the group of permanent hypertensive patients after nifedipine ( - 4 +/- 1 ng/dl, p less than 0.01).