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Nicardipine and hydrochlorothiazide in essential hypertension
T C Fagan1, R Brown, H Schnaper
1General Medicine Section, University of Arizona College of Medicine, Tucson 85724.
Insights
Nicardipine, a calcium channel blocker, effectively lowers blood pressure in hypertensive patients. This study compared nicardipine to hydrochlorothiazide, finding both drugs significantly reduced arterial pressure with manageable side effects.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension remains a significant global health concern.
- Dihydropyridine calcium channel blockers are a key class of antihypertensive agents.
Purpose of the Study:
- To evaluate the efficacy and safety of nicardipine compared to hydrochlorothiazide in patients with hypertension.
- To assess the blood pressure-lowering effects and impact on autonomic reflexes.
Main Methods:
- A double-blind, randomized, multicenter trial involving 151 hypertensive patients.
- Patients received either nicardipine (30 mg t.i.d.) or hydrochlorothiazide (25 mg b.i.d.) for 4 weeks.
- Blood pressure, autonomic reflexes, and urinary sodium excretion were monitored.
Main Results:
- Both nicardipine and hydrochlorothiazide significantly reduced arterial pressure in supine and standing positions (p < 0.01).
- Nicardipine demonstrated rapid blood pressure reduction within 1 hour.
- Nicardipine increased urinary sodium excretion; adverse effects included flushing, headache, and edema.
Conclusions:
- Nicardipine is an effective antihypertensive agent, comparable to hydrochlorothiazide.
- Nicardipine's adverse effects are primarily related to vasodilation.
- Further research may explore nicardipine's role in hypertension management.
Abstract:
Nicardipine is an investigational dihydropyridine calcium channel blocking agent. One hundred fifty-one patients with hypertension received either 30 mg nicardipine t.i.d. or 25 mg hydrochlorothiazide b.i.d. in a double-blind, randomized, multicenter trial. After 4 weeks of therapy and at the end of the dosing interval, nicardipine reduced arterial pressure by 10/6 mm Hg and 12/6 mm Hg in the supine and standing positions, respectively (all p less than 0.01). In the hydrochlorothiazide group, the reductions were 12/6 mm Hg and 14/6 mm Hg, respectively (all p less than 0.01). The maximum reduction in blood pressure of 16/14 mm Hg supine and 20/15 mm Hg standing occurred within 1 hour after administration of nicardipine. The mean reduction in the hydrochlorothiazide group after 1 hour was 14/11 mm Hg supine and 16/12 mm Hg standing. Neither drug affected autonomic reflexes associated with maximum exercise. Nicardipine increased urinary sodium excretion during the 4-hour period after the first dose. Adverse effects of nicardipine were primarily extensions of its vasodilator effect and included flushing, headache, and edema.