Impact of baseline blood pressure on the magnitude of blood pressure lowering by nifedipine gastrointestinal therapeutic system: refreshing the Wilder’s principle

Abstract

BackgroundThe objective of the study was to investigate the relationship between baseline blood pressure (BP) and the magnitude of BP reduction in patients with essential hypertension treated with nifedipine gastrointestinal therapeutic system (NGTS).Methods and patientsOne hundred and thirty-eight patients with essential hypertension were enrolled in this prospective, single-arm, open-label study. NGTS was administered for 24 weeks to achieve target BP of 140/90 mmHg. The dose could be uptitrated to 60 mg/d in case of unsatisfactory BP reduction after 4-week treatment. Home blood pressure measurement was recorded through the initial 1–14 days, and office BP and heart rate were evaluated at 2, 4, 8, 12, and 24 weeks.ResultsOne hundred and seventeen patients (84.8%) completed the study, and their average BP decreased by 19.0/11.3 mmHg after 24 weeks. The reduction of either systolic or diastolic BP was positively correlated with baseline BP at weeks 2, 4, or 24 after treatment (r=0.603–0.762, all p<0.05). The maximal BP reduction was observed in 83% of patients at 4 weeks of treatment even though the dose of nifedipine remained unchanged (30 mg/day).ConclusionThese findings show that BP reduction is greatly influenced by the baseline level. Patients with high baseline BP had maximum reduction after treatment with NGTS, and the maximal antihypertensive efficacy of NGTS could appear even at 4 weeks after treatment initiation.

Mathematical modeling of antihypertensive therapy

“…For example, the reduction in SBP and DBP after simulated treatment with amlodipine was positively correlated with baseline SBP and DBP, respectively. The same relationship was clinically observed for both amlodipine (Kario and Shimada, 1997) and another calcium antagonist, nifedipine (Hu et al, 2017). A number of experimental studies showed a similar trend towards a greater decrease in SBP and DBP among patients with higher baseline SBP and DBP levels when using other antihypertensive regimens,…”

Blood pressure and cardiac autonomic adaptations to isometric exercise training: A randomized sham‐controlled study

“…Second, baseline BP in the IET group was higher than both sham and nointervention control groups. Previous research has identified greater reductions in BP for those with higher baseline BP, thus potentially exaggerating our observed reductions in the IET group (Cornelissen & Smart, 2013;Hu et al, 2017). However, it was a randomized control study, and there were no significant baseline differences in continuous blood pressure measures between the groups.…”

Comparison of the Effects of Self-Administered Moxibustion versus Acupressure on Blood Pressure, Stress, Sleep Quality, and Quality of Life in Hypertensive Patients: A Randomized Parallel Trial

“…The phenomenon that the response to treatment depends on the pre-treatment value (Wilder's principle) is well known, but it is still unclear whether this reflects an actual biological phenomenon or merely a statistical artifact [46]. A similar phenomenon has been observed for the therapeutic response of blood pressure: Patients with higher baseline blood pressures experienced a greater reduction in systolic and diastolic blood pressures with antihypertensive drugs, demonstrating that the baseline level significantly influences the magnitude of the antihypertensive effect of the treatments [47,48]. Similarly, our results showed that the higher the baseline blood pressure, the greater the magnitude of reduction in systolic and diastolic blood pressures.…”