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Isradipine in prediabetic hypertensive subjects
R P Byington1, C D Furberg, T E Craven
1Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1063, USA. bbyingto@rc.phs.wfubmc.edu
Diabetes Care
|December 5, 1998
Summary
In prediabetic patients, dihydropyridine calcium antagonists (CAs) like isradipine may increase cardiovascular disease (CVD) risk, particularly when blood pressure reduction is significant. This finding may explain the ongoing debate surrounding CA use.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Endocrinology
Background:
- The Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS) previously indicated a higher incidence of cardiovascular disease (CVD) events with isradipine compared to diuretics.
- Glycemic indices may influence treatment outcomes in patients with atherosclerosis.
Purpose of the Study:
- To investigate the impact of glycemia indices (serum glucose, insulin, HbA1c) on blood pressure control and CVD events in patients treated with isradipine or hydrochlorothiazide.
- To explore potential reasons for the higher CVD event rate observed with isradipine in the MIDAS trial.
Main Methods:
- 883 patients aged >= 40 with carotid atherosclerosis and diastolic blood pressure > 90 mmHg were randomized.
- Participants received either isradipine (a dihydropyridine calcium antagonist) or hydrochlorothiazide (a diuretic) double-blind for 3 years.
- Patients with insulin-dependent diabetes were excluded, but prediabetic individuals were included based on glycemia indices.
Main Results:
- Both treatment groups achieved comparable diastolic blood pressure control without significant differences in glycemia indices.
- Elevated baseline HbA1c levels, combined with greater blood pressure reduction, were associated with increased cardiovascular events in the isradipine group.
- No statistically significant differences in glycemia indices were observed between groups at baseline or during follow-up.
Conclusions:
- The heightened cardiovascular risk observed with dihydropyridine calcium antagonists in prediabetic patients may contribute to the broader debate on their use.
- Glycemic status, particularly elevated HbA1c, appears to be a critical factor modifying the cardiovascular risk associated with specific antihypertensive agents.