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Hemodynamic and 24-h blood pressure profile of amlodipine monotherapy
M M Ibrahim1, B el-Boghdadly, S S Zaghloul
1Cardiology Department and Diagnostic Ultrasound Laboratory, Cairo University, Egypt.
Objectives:
To test the therapeutic efficacy, hemodynamic profile, changes in arterial compliance, left ventricular mass and side effects of amlodipine monotherapy in hypertensive Egyptians.
Background:
Amlodipine is a dihydropyridine calcium antagonist with prolonged duration of action. Its hemodynamic and hypotensive effects were not reported in hypertensive Egyptians. Hypertension is a major health problem in Egypt. Racial differences in hypotensive efficacy of some drugs have been described.
Methods:
Thirty-two hypertensive patients in stages I and II WHO were recruited from a hypertension clinic. Following 2-4 weeks placebo period 23 patients satisfied inclusion criteria of DBP 95-115 mm Hg. Active amlodipine therapy 5-10 mg was given once daily. Office BP was measured at monthly intervals for 3 months. Ambulatory 24-h blood pressure (ABP) and echo-Doppler studies were performed at the end of placebo and after amlodipine therapy.
Results:
Twenty patients completed the 3 months active treatment period, their age ranged from 30-63 years; 13 were males, body mass index (BMI) was 31 +/- 14 kg/m2 (mean +/- s.d.). Office systolic (S) BP decreased from 152 +/- 14 to 133 +/- 8 mm Hg, diastolic (D) BP from 104 +/- 6 to 89 +/- 8 mm Hg, BP was normalised ( < 140/90 mm Hg) in 13 patients. Heart rate did not change. ABP 24 h, day-time, night time and early morning readings decreased significantly. Amlodipine attenuated SBP rises ( > 140 mm Hg) from 62% to 28% (P < 0.001) and DBP ( > 90 mm Hg) from 73% to 46% (P < 0.001). Cardiac index and left ventricle (LV) functional shortening did not change while systemic vascular resistance decreased from 35 to 29.8 units (P < 0.001). LV mass index decreased from 101 to 96 gm/m2 (NS) and arterial compliance increased from 0.97 to 0.99 ml/mm Hg (NS). Oedema of lower limbs developed in six patients and was the only side effect.
Conclusion:
Amlodipine effectively lowered BP when given as monotherapy to hypertensive Egyptians. It did not influence heart rate, cardiac index or myocardial contractility. Change in LV mass and arterial compliance were not significant.