Effect of verapamil versus nicardipine on 24-hour blood pressure

Thirty patients with uncomplicated, mild to moderate essential hypertension entered a comparative open study of the efficacy and tolerability of slow-release verapamil versus nicardipine. After a 2-week washout period, patients were randomly allocated to receive either verapamil SR 240 mg once daily or nicardipine 40 mg BID for 6 weeks. Lisinopril 10 mg once daily was added after 3 weeks of treatment if the sitting diastolic blood pressure was >95 mmHg. Twenty-four-hour blood pressure monitoring was performed at week 0 and after 3 and 6 weeks of treatment. Within the first 2 weeks, four patients in the nicardipine group withdrew from the study because of tachycardia (n = 2) or headache (n = 2). Three patients in both groups needed the addition of lisinopril. A significant and comparable reduction in systolic and diastolic blood pressures over 24 hours was obtained after 3 and 6 weeks with both treatments (P <0.01). We conclude that verapamil SR 240 mg once daily is an effective and well-tolerated antihypertensive drug that does not interfere with the circadian rhythm of blood pressure. Its once-a-day formulation may increase patient compliance with the antihypertensive treatment.