Verapamil and trandolapril alone and in fixed combination on 24-hour ambulatory blood pressure profiles of patients with moderate essential hypertension

The 24-hour ambulatory blood pressure response to daily treatment with verapamil sustained release (SR) 180 mg once daily, trandolapril 2 mg once daily, or verapamil SR 180 mg/trandolapril 2 mg once daily was investigated in a randomized, double-masked study. This study consisted of a subset of patients of a larger study. Ninety patients (mean age, 55 years) with moderate essential hypertension were enrolled in the study; 24 received verapamil SR 180 mg once daily, 35 received trandolapril 2 mg once daily, and 31 received verapamil SR 180 mg/trandolapril 2 mg once daily therapy for 8 weeks. The 24-hour ambulatory blood pressure measurements were done at baseline and at the end of the treatment period. Treatment with verapamil SR/trandolapril combination therapy produced significantly greater reductions in diastolic blood pressure (DBP) and systolic blood pressure (SBP) than either monotherapy over the 24-hour period, and during the daytime and nighttime monitoring periods (adjusted mean reduction in blood pressure over 24 hours: 18.1/11.1 mm Hg vs 10.7/6.4 mm Hg on trandolapril monotherapy vs 6.9/6.7 mm Hg on verapamil SR monotherapy. Blood pressure remained within the normal range (DBP <90 mm Hg, SBP <140 mm Hg) longer on combination therapy than on either monotherapy. Combination therapy had the most pronounced effect on blunting the early morning rise in blood pressure. Verapamil SR/trandolapril combination therapy may be an appropriate treatment option in patients with moderate essential hypertension, particularly in those who have a tendency toward early morning rise in blood pressure.