I. Slavachevsky et al., Effect of enalapril and nifedipine on orthostatic hypotension in older hypertensive patients, J AM GER SO, 48(7), 2000, pp. 807-810
Citations number
34
Categorie Soggetti
Public Health & Health Care Science","General & Internal Medicine
OBJECTIVE: To compare the effect of enalapril with long-acting nifedipine o
n orthostatic hypotension in older patients. DESIGN: A prospective, double
blinded, cross-over study.
SETTING: The outpatient clinic of a university hospital.
PARTICIPANTS: Thirty-nine patients aged 65 years or older with systolic blo
od pressure (SBP) of 140-190 mm Hg and diastolic blood pressure (DBP) of 90
-110 mm Hg.
INTERVENTION: Enalapril 5-20 mg od or nifedipine 30-90 mg od fur 8 weeks, f
ollowed by 4 weeks washout and cross-over for a second 8-week period.
MEASUREMENTS: Supine and standing 0-, 1-, and 5-minutes blood pressure was
recorded before and at the end of each treatment period.
RESULTS: At baseline, SEP was 158.8 +/- 8.7 mm Hg, and DBP was 97.1 +/- 5.9
mm Hg. There was a decline in SEP of 6.1 +/- 2.7 mm Hg and 8.4 +/- 4.1 mm
Hg after 1 and 5 minutes of standing, respectively. Both agents caused a si
gnificant decline in supine blood pressure. Enalapril: supine SEP 158.8 1 8
.7 to 143 +/- 7.3 mm Hg; supine DBP 97.1 +/- 5.9 to 85.1 +/- 5.1 mm Hg (P =
.0001). The drop in SEP after standing for 5 minutes was only 2.4 +/- 1.6 m
m Hg with no change in diastolic values. A greater than or equal to 10 mm H
g drop in SEP was observed in only three patients, and no patient experienc
ed a decline of 20 mm Hg or more. Nifedipine: supine SEP: 160.3 +/- 9 to 14
5.3 +/- 8.1 mm Hg; supine DBP: 96.3 +/- 5.7 to 86.3 +/- 5,8 (P =.0001). Nif
edipine induced an orthostatic decline in SEP values; there was an 8.7 +/-
4.8 mm Hg difference between supine and 5 minutes standing values (P =.0005
) without change in diastolic values. An orthostatic decline in SEP of grea
ter than or equal to 10 mm Hg occurred in 13 patients, and there was a drop
of greater than or equal to 20 mm Hg in six patients. The cross-over of en
alapril and nifedipine reproduced the hypotensive effect and reversed the p
ostural effect. (P =.0002 nifedipine vs enalapril)
CONCLUSIONS: Enalapril and nifedipine were equipotent in reducing supine bl
ood pressure levels. Enalapril also reduced the number of orthostatic episo
des significantly, whereas nifedipine aggravated this phenomenon.