Calcium Antagonists and Hypertension: Role of co-existent coronary disease, impaired renal function and diabetes
Year: 2007
Type: dissertation
Abstract: It is generally accepted that blood pressure lowering drugs improve the prognosis of patients\nwith elevated blood pressure. The dihydropyridine calcium antagonist nifedipine is a widely\nused blood pressure lowering drug. In the mid-1990ties questions were raised on the safety of\nthe short-acting immediate release formulation of this drug, in particular in patients with coronary\ndisease. To answer these questions in the absence of any prospective safety data from\nrandomised trials, two major studies using a more optimal long-acting GITS (gastro-intestinal\ntherapeutic system) formulation of nifedipine were mounted in the late 1990ties.\nThe Intervention as a Goal in Hypertension Treatment (INSIGHT) randomised double-blind\ntrial compared 30 mg nifedipine GITS (n=3157) to co-amilozide (hydrochlorothiazide 25 μg\nplus amiloride 2•5 mg; n=3164) in patients aged 55-80 years with hypertension (blood pressure\nat least150/95 mmHg, or at least 160 mmHg systolic) who had at least one additional\ncardiovascular risk factor. There was no placebo-treated control group. The main results have\nbeen published elsewhere (Brown MJ et al. Lancet 2000; 356: 366–72). Up-titration followed\nby add-on medication was allowed and resulted in blood pressure control to a similar degree.\nINSIGHT showed that overall nifedipine GITS based treatment was as e_ ective as co-amilozide\nbased treatment in preventing cardiovascular or cerebrovascular complications.\nThe A Coronary disease Trial Investigating Outcome with Nifedipine GITS (ACTION) study compared\nrandomly assigned 60 mg nifedipine GITS (n=3825) to double-blind placebo (n=3840) in\npatients aged at least 35 years with stable angina pectoris and proven coronary artery disease.\nACTION demonstrated that the addition of nifedipine GITS to the conventional treatment of\nangina pectoris is safe, has no e_ ect on major cardiovascular event-free survival and reduces\nthe need for coronary angiography and interventions. The main results of ACTION have been\npublished (Poole-Wilson PA et al. Lancet 2004;364:849-57). The report is reproduced in this\nthesis as chapter 2.\n
Author: Gilbert Wagener
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Bayer, Bayer HealthCare
OpenAlex ID: W2169396233