Comparison of efficacy and safety of cilnidipine and losartan in patients of hypertension with or without diabetes from Gwalior, India
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20171671Keywords:
Blood pressure, Cilnidipine, Diabetes, Heart rate, Hypertension, LosartanAbstract
Background: Hypertension (HTN) is the most common cardiovascular disease. The objectives of present study are to investigate the comparison between cilnidipine and losartan with respect to changes in blood pressure (BP) and heart rate (HR) in hypertensive patients with or without type 2 diabetes mellitus (DM).
Methods: We conducted a longitudinal, prospective, open labelled, comparative clinical study of hypertensive patients with or without type 2 DM. Of 161 enrolled hypertensives, 130 completed the study with follow up over a period of one year. Group I (n=34); and Group III (n = 32) patients with type 2 DM received cilnidipine 10-20mg orally OD. Group II (n =33); and Group IV (n = 31) patients with type 2 DM received losartan 50-100mg orally OD. The dosages were adjusted if the magnitude of reduction was insufficient. The parameters were monitored during follow – up at 4, 8 and 12 weeks.
Results: Levels of systolic and diastolic BP and HR significantly decreased with both drugs. However, magnitude of HR reduction was greater with cilnidipine groups as compared to losartan groups with statistically significant difference (group I 70.79±9.21 versus group II 79.42±8.25, p = 0.000 and group III 76.25±7.08 versus group IV 81±7.15, p = 0.010). Of 161 patients, only 1 patient experienced hot flushes from group I.
Conclusions: The present study demonstrated that therapy with cilnidipine can be used safely and effectively in hypertensive patients with or without diabetes. Cilnidipine was equally efficacious in lowering BP, while it more effectively reduced HR as compared to losartan. Cilnidipine can, therefore, be recommended as an alternative especially when there is associated tachycardia.
References
Goodman and Gilman’s The Pharmacological Basis of Therapeutics. Modulation of cardiovascular treatment of myocardial ischemia and hypertension. Function. 12th ed. Section III: 765-66.
Carretero OA, Oparil S. Essential hypertension. Part I: definition and etiology. Circulation. 2000;101(3):329-35.
Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. NIH Pub #04-5230. National High Blood Pressure Education Program, national heart, lung, and blood institute, national institutes of health; 2004.
Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the multiple risk factor intervention trial. Diabetes Care. 1993;16(2)434-44.
Curb JD, Pressel SL, Cutler JA, Savage PJ, Applegate WB, Black H et al. Effect of diuretic based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. JAMA. 1996;276(23):1886-92.
Katzung BG, Masters SB. Basic and clinical pharmacology. Cardiovascular-renal drugs: antihypertensive agents. 12th ed. Mc Graw Hill;2010.
Fujii S, Kameyama K, Hosono M, Hyashi Y, Kitamure K. Effect of Cilnidipine, a novel dihydropyridine Ca+² channel antagonist on N-type Ca+² channel in rat dorsal root ganglion neuron. J Pharmacol ExpTher. 1997;280:1184-91
Hirning LD, Fox AP, McCleskey EW. Dominant role of N-type Ca2+ channels in evoked release of norepinephrine from sympathetic neurons. Science. 1988;239:57-61.
Sakata K, Shirotani M, Yoshida H, Nawada R, Obayashi K, Togi K et al. Effects of amlodipine and cilnidipine on cardiac sympathetic nervous system and neurohormonal status in essential hypertension. Hypertension. 1999;33:1447-52.
Hoshide S, Kario K, Ishikawa J, Eguchi K, Shimada K. Comparison of the effects of cilnidipine and amlodipine on ambulatory blood pressure. Hypertens Res. 2005;28:1003-8.
Goodman and Gilman’s The Pharmacological Basis of Therapeutics. Modulation of cardiovascular function|: renin and angiotensin. 12th edition, Section III, Chap 26:738.
JNC-8 Panel. Evidence-based guideline for the management of high blood pressure in adults. JAMA. 2014;311:507-20.
Gillman MW, Kannel WB, Belanger A, Agostino RB. Influence of heart rate on mortality among person with hypertension: the Framingham Study. Am Heart J. 1993;125:1148-54.
Furberg CD, Psaty BM, Meyer JV. Nifedipine: dose-related increase in mortality in patients with coronary heart disease. Circulation. 1995;92:1326-31.
Psaty BM, Heckbert SR, Koepsell TD, et al. The risk of myocardial infarction associated with antihypertensive drug therapies. JAMA. 1995,274:620-5.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al. The seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high Blood Pressure: the JNCI report. JAMA. 2003;289:2560-71.
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA 2002;288:2981-97.
Konda T, Enomoto A, Matsushita J, Takahara A, Moriyama T. The N- and L-type calcium channel blocker cilnidipine suppresses renal injury in Dahl rats fed a high-sucrose diet, an experimental model of metabolic syndrome. Nephron Physiol. 2005;101:1-13.
Minami J, Ishimitsu T, Kawano Y, Numabe A, Matsuoka H. Comparison of 24-hour blood pressure, heart rate, and autonomic nerve activity in hypertensive patients treated with cilnidipine or nifedipine retard. J Cardiovasc Pharmacol. 1998;32:331-6.
Minami J, Ishimitsu T, Higashi T, Numabe A, Matsuoka H. Comparison between cilnidipine and nisoldipine with respect to effects on blood pressure and heart rate in hypertensive patients. Hypertens Res. 1998;21:215-9.
Grossman E, Messerli FH. Effect of calcium antagonists on sympathetic activity. Eur Heart J 1998;19:F27-F31.