TRANSDERMAL CLONIDINE AS AN ADJUNCT TO NIFEDIPINE-GITS THERAPY IN PATIENTS WITH MILD-TO-MODERATE HYPERTENSION

Calcium channel blockers and central alpha-agonists are among the clas ses of antihypertensive drugs that yield the most favorable overall ef fects on risk factors for hypertension-related end-organ damage. An op en-label prospective trial in 42 patients with a mean baseline blood p ressure of 144/102 mm Hg sought to assess the usefulness of adjunctive treatment with transdermal clonidine (0.1 to 0.3 mg/day) in patients responding inadequately to nifedipine-gastrointestinal therapeutic sys tem (GITS) (30 to 60 mg/day) monotherapy. Thirty-nine patients who fai led to reach the goal of a seated mean diastolic blood pressure of <90 mm Hg when treated only with once-a-day nifedipine-GITS entered a tra nsdermal clonidine (once a week) titration phase followed by an 8-week maintenance course of the two drugs combined. The 35 patients complet ing this last phase responded with a mean seated diastolic blood press ure of 127/87 mm Hg. Only six patients required the highest dose of cl onidine for control. A 97% compliance rate with the transdermal medica tion contrasted with a compliance rate of only 73% for the oral nifedi pine. Two of three patients who had contact dermatitis after wearing a transdermal clonidine patch withdrew from the trial prematurely; othe r minor side effects required no interruption of therapy. The nifedipi ne-clonidine combination not only achieved blood pressure control in t hese patients but may prove advantageous in combining the protective e ffects of the two agents against complications of the hypertensive syn drome.