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Long-term lipid profiles with isradipine and hydrochlorothiazide treatment in elderly hypertensive patients
G H Stein1, K Matthews, R E Bannatyne
1Ambulatory Care Service, Veterans Administration Medical Center, Gainesville, FL 32602.
Insights
Isradipine, a calcium antagonist, improved HDL cholesterol and the total cholesterol/HDL ratio in elderly hypertensive patients. Concomitant use with hydrochlorothiazide had minimal impact on lipid profiles.
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Background:
- Benign essential hypertension is common in the elderly.
- Hypertension management requires careful consideration of cardiovascular risk factors, including lipid profiles.
- Calcium channel blockers are a common class of antihypertensive medications.
Purpose of the Study:
- To evaluate the effect of isradipine on lipid profiles in elderly patients with hypertension.
- To assess the safety and efficacy of isradipine in blood pressure control over one year.
- To compare lipid profile changes between isradipine monotherapy and combination therapy with hydrochlorothiazide.
Main Methods:
- Open-label, 1-year study involving 56 elderly hypertensive patients.
- Isradipine titration to achieve target blood pressure (<90 mm Hg diastolic).
- Lipid profiles (total cholesterol, HDL, LDL) analyzed at baseline, 6, and 12 months.
Main Results:
- Isradipine monotherapy (n=38) showed significant improvements in HDL cholesterol (+3.9 mg/dl) and total CHOL/HDL ratio (-0.6).
- Isradipine monotherapy also resulted in decreases in total cholesterol (-7.5 mg/dl) and LDL cholesterol (-6.2 mg/dl).
- Combination therapy with hydrochlorothiazide (n=9) showed minimal changes in lipid profiles, with a notable decrease in LDL cholesterol (-16.8 mg/dl).
Conclusions:
- Isradipine monotherapy demonstrated favorable effects on lipid profiles, particularly improving HDL cholesterol and the CHOL/HDL ratio.
- The combination of isradipine and hydrochlorothiazide had a less pronounced effect on lipid profiles compared to isradipine alone.
- Isradipine may offer advantages in managing hypertension in elderly patients due to its potential beneficial impact on lipid metabolism.
Abstract:
Lipid profiles were determined in 56 elderly patients with benign essential hypertension during an open-label 1-year study of the safety and efficacy of isradipine, a new calcium antagonist, in controlling blood pressure. Patients with diastolic blood pressures between 96 and 115 mm Hg were titrated with isradipine (mean dose of 11 mg/day) to reduce blood pressure to less than 90 mm Hg. Ten of these patients received concomitant hydrochlorothiazide (HCTZ) 50 mg/day for additional control. Sera were analyzed using standard methods at the end of a 2- to 4-week washout period, and at the end of Months 6 and 12, for total cholesterol (CHOL) and HDL- and LDL-cholesterol. Changes in lipid values (mg/dl) from baseline to 12 months with isradipine alone (n = 38) were as follows: CHOL, -7.5; HDL, +3.9 (p less than 0.05); LDL, -6.2; CHOL/HDL, -0.6 (p less than 0.05). For patients receiving concomitant HCTZ (n = 9), the changes were as follows: CHOL, -4.9; HDL, +3.4; LDL, -16.8; CHOL/HDL, -0.4. In conclusion, isradipine alone was associated with significant improvements in HDL cholesterol and total CHOL/HDL ratio. Lipid profiles of patients receiving isradipine and HCTZ were minimally affected. Favorable lipid changes with isradipine suggest that it may have advantages in the treatment of hypertensive patients.