ABSTRACT
Revisamos 17 estudos com o objetivo de avaliar a eficácia anti-hipertensiva da combinação de antagonistas de cálcio com bloqueadores dos receptores de angiotensina na redução da pressão arterial, de desfechos cardiovasculares e na incidência de efeitos adversos. A terapia combinada de bloqueador de canais de cálcio anlodipino ou nifedipino GITS, mais o bloqueador de receptor de angiotensina II valsartana, mostrou-se, na maioria dos estudos, mais eficaz que a monoterapia para redução de pressão arterial, além de mais benéfica quanto à diminuição de eventos cardiovasculares. O perfil de segurança e tolerabilidade das combinações também se revelou bastante aceitável, com o manejo de efeitos adversos favorecido pela maior possibilidade de ajustes de doses de substâncias com diferentes mecanismos de ação, sem comprometimento da eficácia anti-hipertensiva.
We reviewed 17 studies in order to evaluate the antihypertensive efficacy on the combination of calcium antagonists and angiotensin receptor blockers in lowering the blood pressure, cardiovascular outcomes and incidence of side effects. The combination therapy of amlodipine or nifedipine GITS calcium channel blockers, and angiotensin II receptor blocker valsartan showed, in most studies, more effective than monotherapy to lower blood pressure, as well as more beneficial to decrease cardiovascular events. The safety profile and tolerability of the combinations also proved quite acceptable, with side effects management benefited by higher possibility of adjustments on doses of substances with different mechanisms of actions, without affecting the antihypertensive efficacy.
Subject(s)
Adrenergic alpha-Antagonists/adverse effects , Amlodipine, Valsartan Drug Combination/adverse effects , NifedipineABSTRACT
Objective To study the antihypertensive efficacy and influence on the blood pressure parameters of nifedipine GITS therapy in patients with subacute cerebral infarction with essential hypertension by ambulatory blood pressure monitoring (ABPM).Methods Fifty-one cases of subacute cerebral infarction with essential hypertension were treated with nifedipine GITS for 14 days.ABPM were performed in all cases before and after treatment.The blood pressure parameters of blood pressure variability (BPV),morning blood pressure surge(MBPS),Trough/Peak(T/P),and smoothness index(SI) were analyzed.Results (1) After treatment with nifedipine GITS 30 mg/d for two weeks,the average 24-hour systolic blood pressure (SBP),day-time systolic blood pressure (dSBP),night-time systolic blood pressure (nSBP),24-hour diastolic blood pressure (DBP),day-time diastolic blood pressure (dDBP),night-time diastolic blood pressure (nDBP) significantly decreased((144.70 ± 14.89) mm Hg vs (163.10 ± 16.48) mm Hg,(145.67 ± 15.20) mm Hg vs (164.55 ±16.81) mm Hg,(140.85 ± 19.46) mm Hg vs (156.73 ±20.55) mm Hg,(81.24 ±8.88) mm Hg vs(89.49 ± 10.06) mm Hg,(81.25 ±9.40) mm Hg vs (90.18 ± 10.64) mm Hg,(81.34 ± 12.10) mm Hg vs (86.28 ±12.11) mmHg;t=11.01,11.53,5.29,8.71,7.53,2.31;P＜0.05)).(2) Defining the standard deviation(SD) of average blood pressure as the indexes of BPV,the blood pressure variability of systolic blood pressure(SBPV),day-time systolic blood pressure variability (dSBPV),night-time systolic blood pressure (nSBPV) decreased significantly ((16.52 ± 4.38) mm Hg vs (19.78 ± 6.72) mm Hg,(15.45 ± 4.71)mm Hg vs (17.88 ± 7.25)mm Hg,(14.94 ± 5.89) mm Hg vs (19.17 ± 8.27) mm Hg; t =3.38,2.19,2.99 ;P ＜0.05)) and the diastolic blood pressure didn't change.(3) There was negative correlation between smoothness index (SI) and BPV (r =-0.28 ; P ＜ 0.05).(4) The decreases of morning blood pressure surge (MBPS) of SBP was more significant after treatment ((22.65 ± 12.77) mm Hg) than that before treatment ((31.94 ±16.36) mm Hg).(5) The median of T/P ratio calculated by group methods was 0.721 for SBP and 0.676 for DBP,and it was 0.588 ± 0.360 for SBP and 0.628 ± 0.433 for DBP calculated by individual method.The medians of T/P ratio were above 0.5 by both methods.Conclusion It is of great significance to effectively control blood pressure and BPV in patients with stroke.Nifedipine GITS can constantly release medicine;it can lower the blood pressure,and significantly reduce BPV and MBPS.
ABSTRACT
Aim To explore the best way of calculating antihypertensive effect of nifedipine GITS on trough to peak ratio (T/PR), and smoothness index (SI) of the drug from ambulatory blood pressure monitoring (ABPM). Methods 32 cases of mild to moderate essential hypertension patients were enrolled and each was given 30 mg of nifedipine GITS once daily. ABPM was repeated for four weeks. ABPM data were analyzed statistically and T/PR calculated by both individual and whole group way. Results The casual blood pressure(CBP) and ABP were lowered by (24?12)/(12?8) mmHg and ( 14.5 ? 3.9 )/( 11.2 ? 3.0) mmHg .The T/PR by individual way was 0.65 ? 0.23 for SBP and 0.66 ? 0.25 for DBP, while by whole group way 0.62 for SBP and 0.68 for DBP. The smoothness index (SI), a new method for assessing the homogeneity of 24 hour blood pressure reduction by antihypertensive therapy, was 3.74 for SBP and 3.77 for DBP after treatment. Conclusion Nifedipine GITS lowers blood pressure effectively and smoothly for 24 hours long. Antihypertensive effects can be reflected by T/PR and SI.
ABSTRACT
PURPOSE: To compare the efficacy and tolerance of felodipine-ER and nifedipine OROS, both once daily, in the treatment of mild-to-moderate uncomplicated arterial hypertension (AH). METHODS: This was a multicentric, opened, randomized, paralled trial, that selected 121 patients with uncomplicated, mild to moderate essential AH (diastolic blood pressure (DBP) > or = 95 and < or = 110 mmHg; not under anti-hypertensive medication. All patients received placebo for two weeks. After that period, they would take either 5mg/day of felodipine, or 30mg/day of nifedipine OROS, both once daily, in a randomized fashion. Patients underwent laboratory tests and electrocardiogram (ECG) at the begining and at the end of the study, and heart rate and blood pressure (BP) measurements, nearly 24 hours after the last active drug dose. RESULTS: Completed the study 111 patients, 60 in the felodipine group and 51 in the nifedipine group. Compared to baseline, the average of systolic BP and DBP decreased from 162.5 +/- 14.3mmHg and from 102.2 +/- 5.1mmHg to 143.3 +/- 14.6 and 87.9 +/- 7.2mmHg, respectively, at the end of the treatment in the felodipine group; and from 160.5 +/- 16.3mmHg and 102.5 +/- 6.2mmHg to 136.1 +/- 14.2 and 86.7 +/- 7.0mmHg, respectively in nifedipine group (p < 0.0001 for all diferences). Adequate BP response to the treatment (DBP normalization or reduction > 10mmHg from baseline) occured in 47/60 (78.3) patients in the felodipine group and in 38/51 (74.5) in the nifedipine group (NS). Side effects, occured in approximately 15 of the cases, and were similar in both groups. These were usually moderate and transient, but were responsible for the withdrawal from the study of two cases in the felodipine group and of three cases in the nifedipine group. CONCLUSION: Felodipine-ER and nifedipine OROS, are similarly effective and generally well tolerated in patients with mild-to-moderate essential hypertension.
Objetivo - Comparar a eficácia e a tolerabilidade da felodipina-ER com a nifedipina-OROS, ambas em dose diária única, no tratamento da hipertensão arterial (HA) leve e moderada, não complicada. Métodos - Estudo multicêntrico, aberto, randomizado e paralelo, incluindo 121 pacientes com HA essencial e nível de pressão arterial diastólica (PAD) >95 e <110mmHg, sem medicação anti-hipertensiva. Após período de 2 semanas de placebo, os pacientes foram randomizados para receber felodipina-ER, 5mg uma vez ao dia, ou nifedipina-OROS, 30mg uma vez ao dia, durante 4 semanas. As medidas da freqüência cardíaca e da pressão arterial (PA) foram sempre registradas cerca de 24h após a última dose. Exames laboratoriais e eletrocardiograma (ECG) foram realizados ao início e ao final do tratamento. Resultados - Completaram o estudo 111 pacientes, 60 no grupo felodipina e 51 no grupo nifedipina. Em comparação com os valores basais, as médias da PA sistólica e da PAD reduziram-se de 162,5±14,3mmHg e de 102,2±5,1mmHg para 143,3±14,6 e 87,9±7,2mmHg, respectivamente, ao final do tratamento, no grupo felodipina; e de 160,5±16,3mmHg e 902,5±6,2mmHg para 136,1±14,2 e 86,7±7,0mmHg, respectivamente, no grupo nifedipina (p< 0,001 para todas as diferenças). Resposta adequada da PA ao tratamento (normalização da PAD ou redução >10mmHg) ocorreu em 47/60 (78,3%) pacientes do grupo felodipina e em 38/51 (74,5%) do grupo nifedipina (NS). Efeitos colaterais, ocorreram em aproximadamente 15% dos casos, com padrão similar em ambos os grupos. Foram em geral moderados e transitórios, porém responsáveis pelo abandono do tratamento em 2 casos do grupo felodipina e em 3 do grupo nifedipina. Conclusão - Felodipina-ER e nifedipina-OROS, foram igualmente eficazes no tratamento da HA leve e moderada, com bom e similar perfil de tolerabilidade