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Nifedipine Could Be First-Line Therapy For Hypertensive Diabetics

Nifedipine, a calcium blocker, could be considered as first-line therapy for hypertensive diabetics.

Investigators in Monza, Italy, assessed outcomes in patients aged 55 to 80 years with hypertension (>/=150/95 or >/=160 mm Hg) and diabetes, or at least one additional cardiovascular risk factor.

Patients received nifedipine 30 mg or co-amilozide (25 mg hydrochlorothiazide and 2.5 mg amiloride) once daily. Doses were doubled if target blood pressures (<140/90 mm Hg) were not achieved.

The primary outcome was a composite of cardiovascular death, myocardial infarction, heart failure and stroke. Secondary outcomes were a composite of primary outcomes, including all-cause mortality and death from vascular and nonvascular causes. The researchers used intent-to-treat analyses to assess both primary and secondary outcomes.

There was no significant difference in the incidence of primary outcomes between the 1,302 nifedipine-treated and co-amilozide-treated patients with diabetes at baseline.

There was a significant benefit for nifedipine-treated patients for the composite secondary outcome.

Among the 5,019 patients without diabetes at baseline, there was a significant difference in the incidence of new diabetes.

Nifedipine GITS, once daily, was as effective as diuretic therapy in reducing cardiovascular complications in hypertensive diabetics, the investigators said. Nifedipine-treated patients were also less likely than those given co-amilozide to have diabetes or to have secondary events (a composite of all-cause mortality, death from a vascular cause, and death from a nonvascular cause).
Hypertension 2003;41:3:431-436. "Outcomes With Nifedipine GITS or Co-Amilozide in Hypertensive Diabetics and Nondiabetics in Intervention as a Goal in Hypertension (INSIGHT)"

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