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Calcium Channel Blockers Differ in Long-Term Tolerability

Although the calcium antagonist amlodipine has an anti-hypertensive effect comparable to both lercanidipine and lacidipine, its tolerability profile is worse.

The three drugs are equally effective in reducing blood pressure, however, report investigators in Milan, Italy.

They observed that whatever the clinical relevance of side effects, these could not be ignored in anti-hypertensive therapy.

The investigators, therefore, assessed the tolerability of the three drugs in a multicentre, double-blind, study with 828 hypertensive patients aged at least 60 years.

Patients were randomised to lercanidipine 10 mg/day (n=420), amlodipine 5.0 mg/day (n=200) or lacidipine 2.0 mg/day (n= 208) for 12 months on average.

If blood pressure control was unsatisfactorily high - 140/90 mm Hg or more - doses were doubled and enalapril or atenolol added, plus a diuretic if needed.

Rates of oedema were significantly higher with amlodipine (19 percent) than with lercanidipine (9.0 percent) or lacidipine (4.0 percent).

Similarly, rates of early study discontinuations due to oedema were significantly higher with amlodipine (8.5 percent) than with lercanidipine (2.1 percent) or lacidipine (1.4 percent).

Likewise, oedema-related symptoms such as lower limb swelling and heaviness occurred significantly more often with amlodipine (45-50 percent than with lercanidipine (33-35 percent) and lacidipine (31-34 percent).

Most oedema cases occurred in the first six months, with differences between the drug treatments evident from the start.

Other drug-related adverse events did not differ between treatments.
American Journal of Hypertension 2002;15(11):932-940. "Tolerability of long-term treatment with lercanidipine versus amlodipine and lacidipine in elderly hypertensives."

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