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Diabetic Hypertensives Improve with Addition of Dihydropyridine Calcium Channel Blocker: Presented at ASH

By Jill Stein

NEW YORK, N.Y. -- May 17, 2006 -- Research suggests that adding a dihydropyridine calcium channel blocker (DCCB) helps control blood pressure in diabetics with uncontrolled hypertension, regardless of their baseline treatment, hypertension type, or demographics.

The findings were reported here on May 17^th at the 21^st Annual Scientific Meeting of the American Society of Hypertension (ASH).

Katherine Hendrix, PhD, executive administrator, Hypertension Initiative, Medical University of South Carolina, Charleston, and colleagues studied the 1-year blood pressure response in patients with concomitant hypertension and diabetes who were given a DCCB added to their existing regimens.

"Patients with hypertension and diabetes are at very high risk for cardiovascular disease," Dr. Hendrix pointed out. "While rigorous blood pressure control reduces adverse outcomes in patients with concomitant hypertension and diabetes, only about 20% of patients with concomitant hypertension and diabetes have blood pressure at the recommended goal of less than 130/80 mm Hg."

Patient information was obtained from the Hypertension Initiative Database, derived mainly from electronic records from several primary care practices in southeastern US.

The 4,958 subjects in the study were at least 18 years old and had uncontrolled blood pressure at baseline. All of them had 1 physician visit before and 2 visits after adding a DCCB and had no other blood pressure medication changes during the year-long trial.

Patient characteristics were similar across hypertension subgroups, which included patients with systolic and diastolic hypertension, patients with isolated systolic hypertension, and patients with isolated diastolic hypertension.

At 1 year after adding a DCCB, substantially more patients reached the blood pressure goal of less than 140/90 mm Hg.

Blood pressure response was greatest in patients with combined systolic/diastolic hypertension, with 33.4% achieving a blood pressure goal of less than 140/90 mm Hg, which represents a post-baseline increase of 24.5%.

Additionally, 42.2% of patients with isolated systolic hypertension had blood pressure less than 140/90 mm Hg 1 year after the DCCB was started. This represents a post-baseline increase of 14.5%.

The percentage of patients with isolated diastolic hypertension with a blood pressure less than 140/90 mm Hg decreased from baseline by 27% to 58.5%. This likely represents a statistical-regression-to-the-mean phenomenon rather than a pathophysiological phenomenon, Dr. Hendrix said. However, almost 25% of this group achieved a blood pressure of less than 130 mm Hg.

Blood pressure reduction after adding the DCCB was not substantially affected by the number of prior blood pressure medications (0-3), age (<65 vs. >65), gender, ethnicity (Caucasian vs. African-American), or site of care (Veterans Administration [VA] vs. non-VA).

Dr. Hendrix cautioned that the results were not adjusted for confounders, which limits comparisons across groups.

The study was supported by Pfizer Inc.


[Presentation title: Adding Dihydropyridine Calcium Channel Blocker Lowers BP in Diabetic Hypertensives Irrespective of Baseline Treatment and Demographics. Abstract P-183]

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