NIFEDIPINE VERSUS CAPTOPRIL IN THE MANAGEMENT OF MODERATE HYPERTENSION IN BLACK PATIENTS

The efficacy of nifedipine (20 to 40 mg twice daily) and captopril (25 to 50 mg twice daily) was assessed during a 12-week single-blind rand omized trial in 41 moderately hypertensive black patients (mean 24-h d iastolic blood pressure [BP] greater than or equal to 90 mm Hg and < 1 15 mm Hg). Nifedipine and captopril were administered as monotherapy i n increasing dosage while a diuretic was added after 8 weeks in patien ts who failed to reach the target BP (24-h mean diastolic BP < 90 mm H g) on monotherapy. After 8 weeks of monotherapy, the mean 24-h ambulat ory BP was reduced from 156 +/- 12/101 +/- 5 to 128 +/- 11/84 +/- 7 mm Hg (P < .0001) in the nifedipine group while it remained essentially unchanged (156 +/- 15/101 +/- 7 to 158 +/- 17/102 +/- 9) in the captop ril group. Left ventricular (LV) mass under was also reduced significa ntly (P < .05) in the nifedipine group, while cardiac index and fracti onal shortening changed marginally. The addition of diuretic in the ca ptopril group (16/21 patients) resulted in a significant fall in BP to 123 +/- 11/81 +/- 7. Only 2/20 patients in the nifedipine group requi red the addition of diuretic. The overall incidence of side effects wa s similar with both treatments but the addition of diuretic in the cap topril group was followed by adverse changes in serum sodium (P < .01) , urea (P < .05), and creatinine (P < .01) levels. It is concluded tha t nifedipine monotherapy offers an effective, safe first-line antihype rtensive treatment in black patients with moderate hypertension while captopril alone failed to control the BP. The combination of captopril and diuretic, although more effective in controlling BP compared with captopril alone, was associated with significant adverse metabolic ef fects.