Calcium channel blocker nifedipine slows down progression of coronary calcification in hypertensive patients compared with diuretics.
Calcium controls numerous events within the vessel wall. Permeability of the endothelium is calcium dependent, as are platelet activation and adhesion, vascular smooth muscle proliferation and migration, and synthesis of fibrous connective tissue. Double-helix computerized tomography is a noninvasive technique that can detect, measure, and compare coronary calcification in the coronary arteries. Using this method, our objective was to determine whether administration of nifedipine once daily in lieu of diuretics in high-risk hypertensive patients will arrest or slow down the progression of coronary artery calcification. The study was designed as a side arm of INSIGHT (International Nifedipine Study: Intervention as Goal for Hypertension Therapy), aimed to show the efficacy of nifedipine once daily versus co-amilozide (hydrochlorothiazide 25 mg, amiloride 2.5 mg) in high-risk hypertensive patients. A total of 201 patients with a total calcium score of >/=10 at the onset of study who underwent an annual double-helix computerized tomography for 3 years were analyzed for efficacy. Inhibition of coronary calcium progression was significant in the nifedipine versus the co-amilozide group during the first year (3.18% versus 27%, respectively, P=0.02), not significant during the second year (28.5% versus 47%, respectively, P=0.14), and significant during the third year (40% versus 78%, respectively, P=0.02). The results point to a slower progression of coronary calcification in hypertensive patients on nifedipine once daily versus co-amilozide.
Motro
M
M
Cardiac Rehabilitation Institute, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel. motrom@post.tau.ac.il
Shemesh
J
J
D000368:Aged; D000584:Amiloride / Q000627:therapeutic use*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000517:prevention & control*; D003324:Coronary Artery Disease / Q000517:prevention & control; D018450:Disease Progression; D004232:Diuretics / Q000627:therapeutic use*; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use*; D006973:Hypertension / Q000000981:diagnostic imaging / Q000517:prevention & control*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
D002121:Calcium Channel Blockers; D004232:Diuretics; D004338:Drug Combinations; D006852:Hydrochlorothiazide; C010247:amiloride, hydrochlorothiazide drug combination; D000584:Amiloride; D009543:Nifedipine