Issue 148 Item 2 Long-Acting Nifedipine Seen as First-Line Option for Hypertensi

Long-acting nifedipine is as effective as conventional antihypertensives for preventing major nonfatal and fatal cardiovascular events in hypertensive diabetics. 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.