Comparative effects of amlodipine and nifedipine GITS during treatment and after missing two doses

Hernández, R.; Armas-Hernández, Mar ́a José; Chourio, José Antonio Colina; Armas-Padilla, Mar ́a Cristina; López, Luis A.; Álvarez, Manuel Penín; Pacheco, Beatriz

doi:10.1097/00126097-200102000-00008

Cited by 20 publications

(10 citation statements)

References 26 publications

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“…The difference became significant beyond 24 hours of drug ingestion. These findings are in keeping with the results of three previous studies of similar design in clinic hypertension …”

Section: Discussionsupporting

confidence: 92%

“…Taken the results of these previous studies and our present study together, amlodipine but not nifedipine‐GITS may maintain its blood pressure–lowering effect after having missed one or two doses of medication. This pharmacologic difference may have clinical implications when a patient's drug adherence is low.…”

Section: Discussionsupporting

confidence: 81%

“…Two double‐blind, double‐dummy, parallel‐group comparison trials also compared blood pressure–lowering efficacy after having missed one or two doses of medication. In an earlier study in 58 patients, amlodipine maintained blood pressure–lowering effect up to 72 hours post‐dose at 58% and 60% of the peak effect on systolic and diastolic pressure, respectively . The corresponding values for nifedipine‐GITS were 14% and 16%, respectively.…”

Section: Discussionmentioning

confidence: 89%

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A randomized controlled trial on the blood pressure–lowering effect of amlodipine and nifedipine‐GITS in sustained hypertension

Huang

Sheng

et al. 2019

J of Clinical Hypertension

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In a multicenter, randomized trial, we investigated whether the long half‐time dihydropyridine calcium channel blocker amlodipine was more efficacious than the gastrointestinal therapeutic system (GITS) formulation of nifedipine in lowering ambulatory blood pressure (BP) in sustained hypertension (clinic systolic/diastolic BP 140‐179/90‐109 mm Hg and 24‐hour systolic/diastolic BP ≥ 130/80 mm Hg). Eligible patients were randomly assigned to amlodipine 5‐10 mg/day or nifedipine‐GITS 30‐60 mg/day. Ambulatory BP monitoring was performed for 24 hours at baseline and 4‐week treatment and for 48 hours at 8‐week treatment with a dose of medication missed on the second day. After 8‐week treatment, BP was similarly reduced in the amlodipine (n = 257) and nifedipine‐GITS groups (n = 248) for both clinic and ambulatory (24‐hour systolic/diastolic BP 10.3/6.5 vs 10.9/6.3 mm Hg, P ≥ 0.24) measurements. However, after missing a dose of medication, ambulatory BP reductions were greater in the amlodipine than nifedipine‐GITS group, with a significant (P ≤ 0.04) between‐group difference in 24‐hour (–1.2 mm Hg) and daytime diastolic BP (–1.5 mm Hg). In conclusion, amlodipine and nifedipine‐GITS were efficacious in reducing 24‐hour BP. When a dose of medication was missed, amlodipine became more efficacious than nifedipine‐GITS.

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“…The difference became significant beyond 24 hours of drug ingestion. These findings are in keeping with the results of three previous studies of similar design in clinic hypertension …”

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 89%

See 1 more Smart Citation

A randomized controlled trial on the blood pressure–lowering effect of amlodipine and nifedipine‐GITS in sustained hypertension

Huang

Sheng

et al. 2019

J of Clinical Hypertension

View full text Add to dashboard Cite

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“…If one or two doses are missed, amlodipine maintains a significant and important antihypertensive effect with the trough-to-peak ratio still over 50% 72-h after the last active dose [29]. Long-acting drugs that have the ability to lower BP over a 24-h period with once per day administration, make the antihypertensive effect more homogeneous over the 24-h and minimize BP variability.…”

Section: Attempt To Do Systematic Reviewmentioning

confidence: 99%

“…Long-acting drugs that have the ability to lower BP over a 24-h period with once per day administration, make the antihypertensive effect more homogeneous over the 24-h and minimize BP variability. It is pragmatically important so that drugs should have preference [29]. …”

Section: Attempt To Do Systematic Reviewmentioning

confidence: 99%

Amlodipine as an antiischemic drug is superior to long acting nitrates

Koraćević

Dakić

Veličković‐Radovanović

et al. 2014

Open Medicine

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AbstractEuropean Society of Cardiology Guidelines cite results of meta-analysis that the use of calcium channel blockers results in fewer angina episodes per week vs. long-acting nitrates. Moreover, we listed 12 reasons more to prefer amlodipine over long-acting nitrates, especially in stable angina pectoris patients with arterial hypertension. It may be the way to decrease polypharmacy without loosing efficacy. Some important advantages of amlodipine versus long-acting nitrate(s) are: amlodipine also treats hypertension, it helps reducing hypertensive target organ damages (e.g. left ventricular hypertrophy) and prevents morning blood pressure surge. Moreover, amlodipine can be given once daily (which improves adherence), it produces neither tolerance nor rebound, it has less side effects.

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Magnitude of and Characteristics Associated With the Treatment of Calcium Channel Blocker–Induced Lower-Extremity Edema With Loop Diuretics

et al. 2019

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IMPORTANCE Calcium channel blockers, specifically dihydropyridine calcium channel blockers (DH CCBs, eg, amlodipine), may cause lower-extremity edema. Anecdotal reports suggest this may result in a prescribing cascade, where DH CCB-induced edema is treated with loop diuretics. OBJECTIVE To assess the magnitude and characteristics of the DH CCB prescribing cascade. DESIGN, SETTING, AND PARTICIPANTS This cohort study used a prescription sequence symmetry analysis to assess loop diuretic initiation before and after the initiation of DH CCBs among patients aged 20 years or older without heart failure. Data from a private insurance claims database from 2005 to 2017 was analyzed. Use of loop diuretics associated with initiation of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and other commonly used medications was used as negative controls. Data were analyzed from March 2019 through October 2019. EXPOSURES Initiation of DH CCB or negative control medications. MAIN OUTCOMES AND MEASURES The temporality of loop diuretic initiation relative to DH CCB or negative control initiation. Secular trend-adjusted sequence ratios (aSRs) with 95% CIs were calculated using data from 360 days before and after initiation of DH CCBs. RESULTS Among 1 206 093 DH CCB initiators, 55 818 patients (4.6%) (33 100 [59.3%] aged <65 years; 32 916 [59.0%] women) had a new loop diuretic prescription 360 days before or after DH CCB initiation, resulting in an aSR of 1.87 (95% CI, 1.84-1.90). An estimated 1.44% of DH CCB initiators experienced the prescribing cascade. The aSR was disproportionately higher among DH CCB initiators who were prescribed high doses (aSR, 2.20; 95% CI, 2.13-2.27), initiated amlodipine (aSR, 1.89; 95% CI, 1.86-1.93), were men (aSR, 1.96; 95% CI, 1.91-2.01), and used fewer antihypertensive classes (aSR, 2.55; 95% CI, 2.47-2.64). The evaluation of ACE inhibitors or ARBs as negative controls suggested hypertension progression may have tempered the incidence of the prescribing cascade (aSR for ACE inhibitors and ARBs, 1.27; 95% CI, 1.24-1.29). CONCLUSIONS AND RELEVANCE This study found an excessive use of loop diuretics following initiation of DH CCBs that cannot be completely explained by secular trends or hypertension progression. The prescribing cascade was more pronounced among those initially prescribed a high dose of DH CCBs.

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Comparative effects of amlodipine and nifedipine GITS during treatment and after missing two doses

Cited by 20 publications

References 26 publications

A randomized controlled trial on the blood pressure–lowering effect of amlodipine and nifedipine‐GITS in sustained hypertension

A randomized controlled trial on the blood pressure–lowering effect of amlodipine and nifedipine‐GITS in sustained hypertension

Amlodipine as an antiischemic drug is superior to long acting nitrates

Magnitude of and Characteristics Associated With the Treatment of Calcium Channel Blocker–Induced Lower-Extremity Edema With Loop Diuretics

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