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Published on: March 22, 2024
Calcium channel blocker nifedipine slows down progression of coronary calcification in hypertensive patients compared
1Cardiac Rehabilitation Institute, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel. motrom@post.tau.ac.il
Insights
Nifedipine significantly slowed coronary artery calcification progression in high-risk hypertensive patients compared to diuretics over three years. This calcium-dependent vascular process was notably inhibited by nifedipine therapy.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Medical Imaging
Background:
- Calcium plays a critical role in vascular wall functions, including endothelial permeability, platelet activation, and smooth muscle cell proliferation.
- Coronary artery calcification is a marker of atherosclerosis and cardiovascular risk.
- Hypertension is a major risk factor for cardiovascular disease, often managed with diuretics or calcium channel blockers.
Purpose of the Study:
- To investigate the effect of daily nifedipine administration versus diuretics on the progression of coronary artery calcification in high-risk hypertensive patients.
- To compare the efficacy of nifedipine once daily against co-amilozide in managing coronary calcification.
Main Methods:
- A 3-year prospective study analyzing data from 201 high-risk hypertensive patients with a baseline coronary calcium score of ≥10.
- Annual assessment of coronary calcification progression using noninvasive double-helix computerized tomography.
- Patients were randomized to receive either nifedipine once daily or co-amilozide.
Main Results:
- Significant inhibition of coronary calcium progression was observed in the nifedipine group compared to the co-amilozide group during the first year (3.18% vs. 27%, P=0.02).
- While not significant in the second year (28.5% vs. 47%, P=0.14), significant inhibition was again noted in the third year (40% vs. 78%, P=0.02).
- Overall, nifedipine demonstrated a slower progression of coronary calcification over the study period.
Conclusions:
- Daily nifedipine administration appears to slow the progression of coronary artery calcification in high-risk hypertensive patients more effectively than diuretics.
- These findings suggest a potential benefit of nifedipine in managing vascular calcification in hypertensive populations.
- Further research may elucidate the mechanisms behind nifedipine's effect on coronary calcification.
Abstract:
Calcium controls numerous events within the vessel wall. Permeability of the endothelium is calcium dependent, as are platelet activation and adhesion, vascular smooth muscle proliferation and migration, and synthesis of fibrous connective tissue. Double-helix computerized tomography is a noninvasive technique that can detect, measure, and compare coronary calcification in the coronary arteries. Using this method, our objective was to determine whether administration of nifedipine once daily in lieu of diuretics in high-risk hypertensive patients will arrest or slow down the progression of coronary artery calcification. The study was designed as a side arm of INSIGHT (International Nifedipine Study: Intervention as Goal for Hypertension Therapy), aimed to show the efficacy of nifedipine once daily versus co-amilozide (hydrochlorothiazide 25 mg, amiloride 2.5 mg) in high-risk hypertensive patients. A total of 201 patients with a total calcium score of >/=10 at the onset of study who underwent an annual double-helix computerized tomography for 3 years were analyzed for efficacy. Inhibition of coronary calcium progression was significant in the nifedipine versus the co-amilozide group during the first year (3.18% versus 27%, respectively, P=0.02), not significant during the second year (28.5% versus 47%, respectively, P=0.14), and significant during the third year (40% versus 78%, respectively, P=0.02). The results point to a slower progression of coronary calcification in hypertensive patients on nifedipine once daily versus co-amilozide.
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