Comparison of nifedipine and captopril as third-line agents in hypertensive patients uncontrolled with beta-blocker and diuretic therapy

The effect of adding either nifedipine or captopril as third-line agents was studied in a single-blind crossover fashion in 24 patients with essential hypertension uncontrolled by combination beta blocker and diuretic therapy. Nineteen patients completed both phases of the study. The mean initial sitting blood pressure before the addition of nifedipine was 164/109 mm Hg and captopril 165/108 mm Hg. Both nifedipine and captopril produced further significant reductions in both sitting and standing blood pressure, 47% of the captopril-treated patients achieving target blood pressure of less than 160/95 mm Hg compared with 67% with nifedipine. Further increase in the dosage resulted in 63% of the captopril- and 81% of the nifedipine-treated patients achieving target blood pressure. There were, however, no statistically significant differences in the mean fall in blood pressure or in the number of patients obtaining target pressure at the end of each treatment period. Captopril treatment also resulted in a small reduction of pulse rate, and, although pulse rates rose with nifedipine, these changes were not significant. Both treatments were generally well tolerated, and serious side effects were not reported. Both nifedipine and captopril were effective and well tolerated as third-line antihypertensive agents.
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