gms | German Medical Science

29. Wissenschaftlicher Kongress der Deutschen Hochdruckliga

Deutsche Hochdruckliga e. V. DHL ® - Deutsche Hypertonie Gesellschaft Deutsches Kompetenzzentrum Bluthochdruck

23. bis 25.11.2005, Berlin

The combination of trandolapril with verapamil reduces SNS activity in hypertensive patients as compared to a combination of ramipril and felodipine

Die Kombination von Trandolapril mit Verapamil reduziert die Sympathikusaktivität bei hypertensiven Patienten im Vergleich zu einer Kombination von Ramipril und Felodipin

Meeting Abstract

  • A. Mitchell - Universitätsklinikum Essen (Essen, D)
  • C.A. Jürgens - Universitätsklinikum Essen (Essen, D)
  • U. Rushentsova - Universitätsklinikum Essen (Essen, D)
  • H.W. Müller - Universitätsklinikum Essen (Essen, D)
  • R. Schäfers - Universitätsklinikum Essen (Essen, D)
  • T. Philipp - Universitätsklinikum Essen (Essen, D)
  • R.R. Wenzel - Universitätsklinikum Essen (Essen, D)

Hypertonie 2005. 29. Wissenschaftlicher Kongress der Deutschen Hochdruckliga. Berlin, 23.-25.11.2005. Düsseldorf, Köln: German Medical Science; 2006. Doc05hochP125

The electronic version of this article is the complete one and can be found online at:

Published: August 8, 2006

© 2006 Mitchell et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: Even retarded dihydropyridine (DHP) calcium antagonists for antihypertensive therapy may activate the sympathetic nervous system (SNS), while non-DHP calcium antagonists may reduce SNS activity. Angiotensin-converting-enzyme (ACE) inhibitors are thought to have no or inhibitory effects on sympathetic tone. Trandolapril/verapamil sustained release (SR) (Tarka) is an oral fixed-dose combination of the ACE inhibitor trandolapril and the SR formulation of the phenylalkylamine calcium antagonist verapamil. We compared the effects of trandolapril/verapamil on SNS activity to those of a fixed-dose combination of the ACE inhibitor ramipril and the retarded DHP calcium antagonist felodipine (Delmuno). We hypothesized that trandolapril/verapamil would reduce SNS activity.

Methods: 34 hypertensive patients were included in a double blind, randomised study and, following a two-week placebo run in, were treated with trandolapril/verapamil 2/180 mg or ramipril/felodipine 5/5mg. Plasma noradrenaline (NA) was measured at baseline and after 8 weeks of treatment. Blood pressure (BP) and heart rate (HR) were secondary parameters. Data were analyzed with t-test or Mann-Whitney test (mean±SD).

Results: Baseline plasma NA concentrations were similar in both treatment arms (P= 0.52). After 8 weeks of treatment, plasma NA was reduced in the trandolapril/verapamil group (-57±146 pg/ml) but was increased in the ramipril/felodipine group (+136±192 pg/ml, P= 0.002 vs. trandolapril/verapamil). BP increased in all patients during the placebo run-in but was lowered to a similar degree by both combinations (delta systolic BP trandolapril/verapamil vs. ramipril/felodipine: -5±18 vs. -15±13 mmHg, P= 0.10; delta diastolic BP trandolapril/verapamil vs. ramipril/felodipine: -10±10 vs. -5±9 mmHg, P= 0.18). HR remained unchanged by either treatment.

Conclusion: Trandolapril/verapamil SR favourably influences SNS activity in hypertensive patients when compared to ramipril/felodipine.