Comparison of the efficacy and metabolic effects of nicardipine and hydrochlorothiazide in hypertensive black men and women.
A double-blind, randomised, parallel study compared the BP and metabolic responses in black hypertensive patients following monotherapy with nicardipine or hydrochlorothiazide (HCTZ). Following a single-blind placebo wash-out period of 1-4 weeks, the study drug, nicardipine 20-40 mg three times daily or HCTZ 25-100 mg four times daily, was administered in a double-blind fashion for 12 weeks. Doses were titrated to control sitting DBP (< or = 90 mmHg). Both drugs were effective in reducing sitting SBP and DBP as compared with baseline values (nicardipine: 152.5 +/- 1.6/102.0 +/- 0.6, HCTZ: 152.5 +/- 1.5/101.4 +/- 0.5 mmHg). DBP responses (reduction from baseline; nicardipine: -10.9, HCTZ: -12.7 mmHg), and the percentage of patients achieving a response < or = 90 mmHg (nicardipine: 54%, HCTZ: 63%) to the two drugs were similar. Although SBPs at baseline and endpoint (137.3 +/- 1.6 on nicardipine and 132.1 +/- 1.4 mmHg on HCTZ), and the percentage of patients achieving a response < or = 140 mmHg (nicardipine: 70%, HCTZ: 79%), were comparable between the two treatments, the SBP reduction with HCTZ was statistically greater (P = 0.026). A comparison of the metabolic responses in the two treatment groups showed significant differences. Nicardipine caused no significant changes in blood chemistry, whereas HCTZ caused statistically significant decreases (P < 0.001) in sodium and potassium and increases (P < or = 0.01) in glucose, BUN, creatinine, uric acid, cholesterol and LDL compared with baseline. In 12.7% of the patients in the HCTZ group, serum potassium dropped to levels < 3.5 meq/l, which occurred in only 1.4% of the patients who used nicardipine.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Medicine, University of Maryland Hospital, Baltimore 21201.
M R
MR
Weir
J T
JT
Wright
K C
KC
Ferdinand
C A
CA
Cook
D
D
Champion
S
S
Wong
P A
PA
Jenkins
B W
BW
Kong
D000328:Adult; D000368:Aged; D044383:Black People; D001786:Blood Glucose / Q000032:analysis; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000652:urine; D004311:Double-Blind Method; D005260:Female; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000592:standards* / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000009:adverse effects / Q000592:standards* / Q000627:therapeutic use; D011188:Potassium / Q000097:blood; D012727:Sex Characteristics; D012964:Sodium / Q000097:blood
D001786:Blood Glucose; D006852:Hydrochlorothiazide; D002784:Cholesterol; D012964:Sodium; D003404:Creatinine; D009529:Nicardipine; D011188:Potassium