THE ANTIHYPERTENSIVE EFFICACY AND TOLERABILITY OF A LOW-DOSE COMBINATION OF RAMIPRIL AND FELODIPINE ER IN MILD-TO-MODERATE ESSENTIAL-HYPERTENSION

1 The antihypertensive efficacy and tolerability of a low dose combina tion of the angiotensin converting enzyme inhibitor ramipril (2.5 mg) and the extended release formulation of the dihydropyridine calcium ch annel antagonist felodipine (5 mg) were assessed in a double-blind, do uble dummy placebo controlled, randomised, crossover study in 20 patie nts (mean age 55.4 years; range 46-69) with uncomplicated mild to mode rate hypertension (supine diastolic >90 mmHg <115 mmHg after 4 weeks o f single-blind wash-out on placebo). The four randomised, double-blind , crossover study phases evaluated the response to 4 weeks of once dai ly treatment with placebo, monotherapy with each drug and the combinat ion. Noninvasive ambulatory blood pressure monitoring (Spacelabs 90207 ) was performed for 24 h at the end of each phase. 2 The mean 24 h amb ulatory blood pressure (mmHg) was 147.9/92.0 following placebo, 141.3/ 87.8 following monotherapy with ramipril 2.5 mg, 136.8/85.8 following monotherapy with felodipine ER 5 mg and 131.1/82.6 following the combi nation of ramipril 2.5 mg and felodipine ER 5 mg. All active treatment phases significantly reduced mean 24 h ambulatory diastolic pressure by comparison with placebo. The antihypertensive efficacy of the combi nation was additive. 3 The coadministration of ramipril did not attenu ate the incidence of headache attributable to felodipine ER.