Antihypertensive effects of parenteral nicardipine alone and in combination with captopril

We studied the safety and efficacy of intravenous nicardipine alone and in combination with oral captopril. Sixteen patients with essential hypertension received a single oral dose of captopril, 50 mg, to be certain that excessive hypotension would not occur. Nicardipine was given intravenously as a 2 mg bolus, followed by an infusion at a rate designed to lower the supine diastolic blood pressure at least 10 mm Hg; then oral captopril, 50 mg, or placebo was given. The next week, nicardipine was again infused, but the alternate oral treatment was given. Intravenous nicardipine reduced blood pressure from 156 ± 15 101 ± 5 mm Hg (mean arterial blood pressure 120 ± 6 mm Hg) to 140 ± 11 88 ± 4 mm Hg (mean arterial blood pressure 105 ± 5 mm Hg). When captopril was added to nicardipine, the mean arterial blood pressure fell an additional 8 mm Hg but the heart rate did not increase. The combination of angiotensin-converting enzyme inhibition and calcium channel blockade produces additive antihypertensive effects without additional reflex tachycardia.