Hepatocellular necrosis associated with labetalol.

ambulatory blood pressure (BP) as well as on the magnitude of leg edema of treatments using LER, amlodipine (AML), or hydrochlorothiazide (HCT) in patients with confirmed ambulatory hypertension (daytime systolic BP 135mmHg). A total of 121 eligible patients (66M/55F, mean age of 62.7 7.1 yrs) were randomized to either LER 10 mg (n 39), AML 5 mg (n 39) or HCT 12.5 mg (n 43) for 4 weeks. They were then force-titrated to LER 20 mg, AML 10 mg and HCT 25 mg for 4 weeks of treatment. Ambulatory BP monitoring was performed at baseline and after each of the 4-week treatment period (week 4 and 8). The magnitude of leg edema was evaluated using the leg volume measured by water deplacement volumetry at the same timepoints both in the morning at trough and in the afternoon. Daytime ambulatory systolic/diastolic BP were comparable for the LER (150.0/88.6 mmHg), AML (153.2/88.7 mmHg) and HCT (151.8/ 86.5 mmHg) treatment groups at baseline. Mean daytime systolic/diastolic BP (mm Hg) were reduced by treatments with LER (-3.4/-0.9 and -5.6/-2.1), AML (-10.2/-4.7 and -17.4/-9.2) and HCT (-3.9/-1.3 and -6.8/-3.5) at week 4 and week 8, respectively. However, LER induced BP decrements significantly (p 0.001) less pronounced than those obtained after AML treatment but comparable to HCT treatment. Changes in leg volume were significantly (p 0.05) more important with AML in the morning as compared with LER at week 4 ( 27.6 vs -39.2 ml) and at week 8 ( 128.0 vs -19.0 ml). Similarly, leg volumes with AML as compared with LER were significantly different at week 4 ( 21.6 vs -2.6 ml) and week 8 ( 138.0 vs 36.3 ml), as measured in the afternoon. HCT decreased leg volume in the morning and in the afternoon at week 4 (-22.6 and -0.8 ml) and at week 8 (-47.6 and -11.1 ml), respectively. The results of the present study demonstrate that the dihydropyridine calcium antagonist LER induced significantly less leg edema than AML but similarly to HCT as measured by leg volume. However, this beneficial effect of LER was associated with significantly less antihypertensive efficacy on ambulatory BP as compared with AML.