We compared haemodynamic and humoral responses to nifedipine and nilvadipine in 25 elderly hypertensives. The study had a single-blind crossover design. Doppler flowmetry and laboratory examinations were performed before and after nifedipine and nilvadipine. Both nifedipine and nilvadipine significantly reduced mean arterial pressure to the same extent. Nilvadipine increased cardiac output, carotid flow and vertebral flow whereas nifedipine had no significant effect on either cardiac output or regional blood flows. Nilvadipine increased plasma atrial natriuretic peptide and decreased plasma noradrenaline. In the nilvadipine group, the relations between changes in these humoral parameters and those in cardiac output suggest that an elevation of pre-load may play a role in increasing cardiac output. The effects of nilvadipine on cerebral perfusion might provide additional benefits for the elderly hypertensives.