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Reduction of cardiovascular structural changes by nifedipine GITS in essential hypertensive patients
E Agabiti-Rosei1, R Zulli, M L Muiesan
1Semeiotica and Metodologia Medica, UOP Scienze Mediche, University of Brescia, Italy.
Insights
Nifedipine GITS and hydrochlorothiazide effectively lower blood pressure in hypertensive patients with left ventricular hypertrophy. Nifedipine GITS demonstrated a greater reduction in minimal vascular resistance and left ventricular mass index compared to hydrochlorothiazide.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Essential hypertension is often associated with left ventricular hypertrophy (LVH).
- Left ventricular mass and vascular resistance are key indicators of cardiovascular risk in hypertensive patients.
Purpose of the Study:
- To compare the effects of Nifedipine GITS and hydrochlorothiazide (HCTZ) on reducing left ventricular mass and minimal vascular resistance in essential hypertensives with LVH.
- To analyze the impact on blood pressure and echocardiographic LV functional parameters.
Main Methods:
- Double-blind, randomized comparison of Nifedipine GITS versus HCTZ.
- Echocardiography used to measure left ventricular mass index (LVMI).
- Strain gauge plethysmography used to measure forearm minimal vascular resistance.
Main Results:
- Both Nifedipine GITS and HCTZ significantly reduced systolic and diastolic blood pressure.
- Nifedipine GITS monotherapy showed a progressive decrease in LVMI over 24 weeks.
- Nifedipine GITS monotherapy significantly reduced minimal vascular resistance, with a greater effect than HCTZ.
Conclusions:
- Nifedipine GITS, alone or combined with HCTZ, significantly reduces LVMI and vascular structural changes in hypertensive patients with LVH.
- Nifedipine GITS monotherapy offers a superior reduction in minimal vascular resistance compared to HCTZ monotherapy.
Abstract:
The aim of this study was to evaluate the effect of the calcium antagonist Nifedipine GITS in a double-blind, randomized comparison with the diuretic hydrochlorothiazide (HCTZ) on reduction of left ventricular (LV) mass and minimal vascular resistance in a group of essential hypertensives with left ventricular hypertrophy (LVH). The effects on blood pressure and on echocardiographic LV functional parameters were also analysed. After two months of randomized treatment with Nifedipine GITS or HCTZ, if diastolic blood pressure was > 90 mmHg, a combination of the two drugs was given and was continued for 24 weeks. M-mode, 2D-guided echocardiography was used to measure LV mass index (LVMI) according to the "Penn convention". Minimal vascular resistance was measured in the forearm, from arterial pressure and maximal blood flow, using a strain gauge plethysmography. All examinations were performed before and after 8 and 24 weeks of treatment. Changes in LVMI were analysed at 8 weeks and at 24 weeks in patients receiving monotherapy ("according to protocol" analysis), and also at the end of treatment in patients taking Nifedipine or HCTZ monotherapy or the combination of the two drugs ("intention to treat" analysis). Both Nifedipine and HCTZ significantly reduced systolic and diastolic blood pressure (p < 0.001), without any significant difference between the two drug treatments. Heart rate was not significantly modified by either treatment. A progressive decrease in LVMI was observed after 8 and 24 weeks of treatment with Nifedipine monotherapy (ANOVA, p = 0.03), while the decrease in LVMI during HCTZ treatment did not progress further at 24 weeks (ANOVA, p = 0.49). A significant reduction of minimal vascular resistance was observed in patients treated with Nifedipine GITS monotherapy (ANOVA, p = 0.001), but not in the HCTZ group (ANOVA, p = 0.06). Comparison of changes of forearm minimal vascular resistance, considering baseline values, could demonstrate a greater effect during Nifedipine monotherapy as compared to HCTZ monotherapy. In conclusion, in a group of hypertensive patients with LVH, treatment for 24 weeks with Nifedipine GITS alone or in combination with HCTZ induced a significant reduction in LVMI and of forearm vascular structural changes, as evaluated by minimal vascular resistance. The decrease of minimal vascular resistance was significantly greater in patients treated with Nifedipine monotherapy, as compared to those given HCTZ.