Effects of nifedipine GITS and diuretics in isolated systolic hypertension--a subanalysis of the INSIGHT study.
OBJECTIVE
This study tested the effects on cardiovascular outcomes of treatments based on nifedipine gastrointestinal therapeutic system (GITS) compared with the diuretic combination co-amilozide in a pre-specified subset of patients with isolated systolic hypertension (ISH) enrolled in the International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT) study.


RESULTS
Of 6321 randomized patients, 1498 (23.7%) had ISH with a baseline mean BP of 173/88 mmHg in both treatment groups. Mean BP fell by 29/10 mmHg in the nifedipine and 30/10 mmHg in the diuretic group to a mean BP of 144/78 mmHg and 143/79 mmHg, respectively, at endpoint. The percentage of primary outcomes in patients with ISH was not significantly different between the two treatment groups (nifedipine GITS 6.0%, co-amilozide 6.6%). The number of ISH patients with composite secondary outcomes was 90 (12.2%) in the nifedipine GITS group and 110 (14.5%) in the co-amilozide group (not significant). The incidence rates of primary and secondary outcomes were similar in patients without ISH.


CONCLUSIONS
In patients with ISH, nifedipine GITS and co-amilozide had similar effects on clinical outcomes and BP lowering. They lend support to international guidelines for the treatment of hypertension recommending the use of long-acting dihydropyridine calcium-channel blockers as one treatment option for patients with ISH.
Mancia
Guiseppe
G
University of Milano-Bicocca ,St Gerardo Hospital, Monza, Milan, Italy. guiseppe.mancia@unimib.it
Ruilope
Luis
L
Palmer
Christopher
C
Brown
Morris
M
Castaigne
Alain
A
De Leeuw
Peter
P
Rosental
Talma
T
Wagener
Gilbert
G
D000368:Aged; D000369:Aged, 80 and over; D000584:Amiloride / Q000008:administration & dosage / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage* / Q000627:therapeutic use; D004232:Diuretics / Q000008:administration & dosage* / Q000627:therapeutic use; D004304:Dosage Forms; D004311:Double-Blind Method; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies
D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D004304:Dosage Forms; D004338:Drug Combinations; D006852:Hydrochlorothiazide; C010247:amiloride, hydrochlorothiazide drug combination; D000584:Amiloride; D009543:Nifedipine