ATENOLOL NIFEDIPINE COMBINATION - EFFICACY AND TOLERABILITY OF LOW-DOSE SYNERGISTIC BITHERAPY FOR THE TREATMENT OF ARTERIAL-HYPERTENSION/

During recent decades, undeniable progress has been made with regard t o the management of arterial hypertension. Larger numbers of patients are aware they have hypertension, receive treatment and benefit from t his therapy. Furthermore, significant reductions have been observed in morbidity and mortality resulting from cardiovascular diseases. The o bjectives of hypertension treatment have been formulated on the basis of results of extensive epidemiological studies. Only a few patients r eceiving monotherapy actually achieve and maintain acceptable blood pr essure levels. The complex pathogenesis of essential hypertension, the implications of nervous and humoral counter-regulatory effects, the h eterogeneous character of individual responses to any given class of a ntihypertensive treatment and the onset of adverse effects all account for these failures. The search for a simple, effective and well-toler ated treatment based on a low dose combination of 2 classes of antihyp ertensive agents is consequently legitimate. The fixed combination of atenolol 50mg and sustained release nifedipine 20mg enables patients t o benefit from the antihypertensive synergy of a P-blocker and a calci um antagonist (dihydropyridine). Several open-ended or double-blind, c ontrolled studies have shown that this combination produces a more mar ked antihypertensive effect than the individual components used alone or other reference monotherapies. Furthermore, it has been shown that this effect persists throughout the entire 24-hour period; this has be en confirmed by 24-hour blood pressure monitoring. Short and medium te rm tolerability is significantly improved: the side effects commonly a ssociated with the 2 drugs when used alone are reduced with the combin ation formulation since the 2 active substances have different and com plementary mechanisms of action. In addition, long term studies have s hown that therapeutic efficacy and tolerability remain stable and have even been seen to improve over a 12-month period. The fixed combinati on of atenolol-nifedipine has a role in strategies for the treatment o f mild to moderate hypertension, particularly under the following cond itions: - when first-line monotherapy has failed to attain specific cl early defined objectives, including stabilised blood pressure levels t ogether with acceptable tolerability - when patient compliance is jeop ardised as a result of undesirable side effects - when the vascular bu rden is aggravated through lack of attention to individual risk factor s in hypertensive patients. In more serious forms of hypertension, the atenolol-nifedipine combination can replace sequential monotherapies or other combination treatments that have failed to comply with the va rious criteria of therapeutic efficacy. Controlling arterial hypertens ion commonly requires polytherapy with 3 or even 4 different drugs in conjunction with particularly strict rules governing hygiene and diet. The addition of the fixed combination of atenolol-nifedipine simplifi es the treatment of patients with arterial hypertension by limiting th e daily doses and reducing laboratory monitoring.