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Sustained calcium channel blockade in the treatment of severe hypertension. A two year experience
M Geizhals1, R A Phillips, M Ardeljan
1Department of Medicine, Mount Sinai Medical Center, New York City, NY 10029.
Insights
Nifedipine gastrointestinal therapeutic system (GITS) effectively controls severe hypertension, significantly reducing blood pressure and left ventricular hypertrophy. This treatment is well-tolerated as monotherapy for long-term management.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Severe hypertension poses significant health risks.
- Effective long-term management strategies are crucial.
Purpose of the Study:
- To evaluate the efficacy and tolerability of nifedipine gastrointestinal therapeutic system (GITS) for severe hypertension.
- To assess the impact of nifedipine GITS on left ventricular hypertrophy.
Main Methods:
- Thirty-nine patients with severe hypertension (diastolic blood pressure > 120 mm Hg) received nifedipine GITS.
- Blood pressure and echocardiographic measurements were recorded over 18 months.
- Treatment adherence and adverse events were monitored.
Main Results:
- 75% of patients achieved target blood pressure (< 95 mm Hg diastolic) with nifedipine GITS monotherapy.
- Significant reductions in systolic/diastolic blood pressure were observed at 6, 12, and 18 months.
- Left ventricular hypertrophy diminished significantly; 44% remained in treatment after two years with no severe medical events.
Conclusions:
- Nifedipine GITS is a well-tolerated and effective monotherapy for severe hypertension.
- Sustained blood pressure control and regression of left ventricular hypertrophy were achieved.
- High dosage (≥ 90 mg/day) was often required for optimal outcomes.
Abstract:
Thirty-nine patients with severe hypertension (diastolic blood pressure greater than 120 mm Hg) predominantly drawn from an inner-city population were placed on nifedipine gastrointestinal therapeutic system (GITS) for long-term treatment to achieve a sustained diastolic blood pressure less than 95 mm Hg. Fourteen patients failed to complete 6 months of therapy. For the 25 who remained in treatment for 6 months or more, systolic/diastolic blood pressure reductions were 62 +/- 5/40 +/- 2 mm Hg at 6 months; for those followed more than 12 months (n = 18), 58 +/- 7/37 +/- 3 mm Hg at 12 months; and for those followed more than 18 months (n = 11), 54 +/- 6/37 +/- 3 mm Hg at 18 months. Overall, 75% of these severely hypertensive patients were controlled with nifedipine GITS alone; 80% required 90 mg/day or more. During the two years of observation, no patient had a severe medical event, and 44% of those who entered remain in treatment. Left ventricular hypertrophy, as determined by echocardiography, diminished significantly during the course of treatment. These results indicate nifedipine GITS is well-tolerated and effective as monotherapy in the treatment of severe hypertension.