Management of severe hypertension with nifedipine in combination with clonidine or propranolol

The hypotensive effect of nifedipine was studied in 9 patients with severe hypertension. After oral administration of 20 mg nifedipine mean arterial pressure (MAP) fell, reaching lowest values about 1 h p.a. The antihypertensive effect lasted 7 h. Treatment with nifedipine alone (80 mg/day) lowered MAP significantly on the first day, but it tended to rise again thereafter. Addition of clonidine (450 μg/day) or propranolol (120 mg/day) enhanced the hypotensive effect. Furosemide (120 mg/day) was ineffective when added to the above described regimen. Without nifedipine the combined drugs failed to keep MAP down. The decrease of MAP observed when giving this combination of drugs was associated with a significant fall in total peripheral resistance and plasma renin activity, but did not alter cardiac output and blood volume. We concluded that nifedipine together with clonidine or propranolol is very effective in the management of severe hypertension.