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Review of long-term trials with nitrendipine
1Department of Endocrinology, Lund University Clinics, Malmö General Hospital, Sweden.
Insights
Nitrendipine, a calcium channel blocker, effectively lowers blood pressure in essential hypertension by dilating blood vessels. It shows sustained efficacy and is well-tolerated, with no adverse metabolic effects.
Area of Science:
- Cardiovascular Pharmacology
- Hypertension Management
Background:
- Essential hypertension requires effective antihypertensive treatments.
- Dihydropyridine calcium antagonists offer a pathophysiologically targeted approach.
Purpose of the Study:
- To evaluate the efficacy and tolerability of nitrendipine in treating essential hypertension.
- To assess long-term effects and specific patient group responses.
Main Methods:
- Clinical assessment of blood pressure reduction.
- Monitoring of sympathetic nervous system and renin-angiotensin system activity.
- Evaluation of side effects and metabolic parameters.
Main Results:
- Nitrendipine demonstrated potent vasodilation and antihypertensive effects, comparable to diuretics and beta-blockers.
- Sustained blood pressure reduction observed in responders; enhanced efficacy in elderly and black patients.
- Common side effects (headache, flush) were mild and transient; no adverse metabolic or electrolyte disturbances.
Conclusions:
- Nitrendipine is an effective antihypertensive agent for essential hypertension, with sustained efficacy and a favorable side effect profile.
- It does not stimulate the sympathetic nervous or renin-angiotensin systems and has no adverse metabolic effects.
- Further research is needed on its role in preventing cardiovascular complications and reversing left ventricular hypertrophy.
Abstract:
The dihydropyridine calcium antagonist nitrendipine offers a pathophysiologically based antihypertensive treatment with a potent dilation of resistance vessels, increased arterial compliance, and an acute natriuretic/diuretic response. Prolonged nitrendipine treatment in essential hypertension is not associated with stimulation of the sympathetic nervous and the renin-angiotensin systems or accumulation of sodium and water. The antihypertensive effectiveness is similar to that of diuretics and beta-blockers, and the responsiveness appears to be greater in elderly and black patients. During long-term (approximately 1 year) nitrendipine treatment in mild to moderate hypertension, the blood pressure reduction is well sustained in "short-term" nitrendipine responders. In patients with severe hypertension, nitrendipine has a potent antihypertensive effect in combination with beta-blockers and/or diuretics. In mild-moderate hypertension, a single daily dose (10-40 mg) may be sufficient, whereas two daily doses (20-80 mg/day) seem necessary in severe hypertension. Common side effects are headache, flush, and palpitations (approximately 20-30%), but these are generally mild and transient. Dizziness and malaise occur in approximately 5%, often later during treatment. Peripheral edema in 5-20% of the patients is generally mild but persistent. Nitrendipine has no adverse effects on glucose and lipid metabolism or on plasma levels of electrolytes and urate. The ultimate aim of antihypertensive treatment is to prevent cardiovascular complications. As for other calcium antagonists, no study on primary prevention of cardiovascular complications in hypertension has been published. With regard to regression of left ventricular hypertrophy accompanying essential hypertension, conflicting results have been found with nitrendipine.