Tolerability and safety of a calcium channel blocker in comparison with a diuretic in the treatment of elderly patients with hypertension: secondary analysis of the NICS-EH.
A randomized prospective controlled study, the National Interventional Cooperative Study in Elderly Hypertensives (NICS-EH), previously demonstrated that the preventive effect of the long-acting calcium channel blocker nicardipine on the cardiovascular endpoint was similar to that of the diuretic, trichlormethiazide. The present report is a sub-analysis in which we compare the tolerability and safety of the calcium channel blocker with that of a diuretic in the long-term treatment of elderly hypertensives. A total of 429 elderly patients with hypertension were assigned to the nicardipine group or the diuretic group by the double-dummy method and were followed up for 5 years. Two hundred four patients in the nicardipine group and 210 patients in the diuretic group were analyzed. The incidences of fatal and nonfatal cardiovascular (CV) events in the two groups were comparable, and there was no significant difference in the cumulative event-free rate. However, the total incidence of adverse reactions, including non-CV events and unfavorable BP changes, was 31 cases (15.2%) in the nicardipine group, which was significantly lower than the 47 cases (22.4%) in the diuretic group (log-rank: p=0.026, G. Wilcoxon: p=0.01). The total number of medical endpoints, including CV events, the withdrawal of the patient from the study, was 52 (25.5%) in the nicardipine group, which was significantly lower than the 65 (31.0%) in the diuretic group (log-rank: p=0.078, G. Wilcoxon: p=0.044). It was concluded that sustained-release nicardipine is better tolerated, as it exhibits a lower incidence of medical-related withdrawals such as adverse drug reactions, non-cardiovascular events and unfavorable BP responses during the treatment.
Kuwajima
I
I
Division of Cardiology, Tokyo Metropolitan Geriatric Hospital, Japan. kuwajima@tmig.or.jp
Kuramoto
K
K
Ogihara
T
T
Iimura
O
O
Abe
K
K
Saruta
T
T
Ishii
M
M
Hiwada
K
K
Fujishima
M
M
Fukiyama
K
K
D000368:Aged; D002121:Calcium Channel Blockers / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D004232:Diuretics; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage* / Q000009:adverse effects; D010352:Patient Dropouts; D011446:Prospective Studies; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage; D014237:Trichlormethiazide / Q000008:administration & dosage
D002121:Calcium Channel Blockers; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D009529:Nicardipine; D014237:Trichlormethiazide