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Item #2
Long-Acting
Nifedipine Seen as First-Line Option for Hypertensive Diabetics
Long-acting
nifedipine is as effective as conventional antihypertensives for
preventing major nonfatal and fatal cardiovascular events in
hypertensive diabetics.
Results of a substudy of the Intervention as a Goal in Hypertension
Treatment (INSIGHT) study suggest that nifedipine could be considered
a first-line treatment for hypertensive patients with diabetes.
In
the original INSIGHT trial, long-acting daily nifedipine (30 mg) was
as effective as daily co-amilozide (25 mg hydrochlorathiazide/2.5 mg
amiloride) in controlling blood pressure and reducing the incidence of
cardiac-related events in 6321 hypertensive patients with at least one
additional cardiovascular risk factor.
In
the March issue of Hypertension, the INSIGHT investigators describe
cardiovascular outcomes in a subgroup of 1302 patients who had
diabetes at baseline.
There
were no significant differences in the incidence of MI, stroke,
congestive heart failure, and cardiovascular death in nifedipine- and
co-amilozide-treated diabetics (8.3% vs. 8.4%), Dr. Giuseppe Mancia of
the University of Milan in Italy and colleagues report.
However,
treatment with nifedipine was associated with a significantly lower
incidence of vascular and nonvascular deaths combined (p = 0.03).
Also,
there were significantly fewer new cases of diabetes mellitus (p =
0.023) in the nifedipine group. Specifically, among the 5019 patients
free of diabetes at baseline, the incidence of new cases of diabetes
was 4.3% in the nifedipine group versus 5.6% in the co-amilozide
group.
So,
contrary to concerns raised previously about the effectiveness of
calcium channel blockers in diabetic hypertensives, the INSIGHT
investigators conclude that these findings indicate that long-acting
nifedipine is as effective as conventional antihypertensives for
preventing major nonfatal and fatal cardiovascular events in
hypertensive diabetics
The
data strengthen the conclusion that official treatment of diabetic
patients can count on several drugs, [including] certainly calcium
channel blockers. This is important for medical practice because
rigorous blood pressure control is mandatory in diabetes to prevent
cardiovascular complications. Hypertension
2003;41:431-436
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FACT:
The best predictors of cardiovascular disease in patients
with Type 2 diabetes are
dyslipidemia, elevated blood pressure, smoking and hyperglycemia.
N
Engl J Med 1998; 339:229–34.
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