G. Rossetti

Antihypertensive Effect of Barnidipine 10 mg or Amlodipine 5 to 10 mg Once Daily in Treatment-Naive Patients with Essential Hypertension : A 24-Week, Randomized, Open-Label, Pilot Study

BACKGROUND Dihydropyridine calcium antagonists are largely employed for the treatment of hypertension, coronary heart disease, and heart failure. OBJECTIVE The aim of our study was to compare the antihypertensive effect of the dihydropyridine calcium antagonists barnidipine and amlodipine. METHODS This was a 24-week, randomized, open-label, pilot study. Consecutive treatment-naive patients with grade I or II essential hypertension (office sitting systolic blood pressure [BP] of 140-179 mm Hg and diastolic BP of 90-109 mm Hg) were enrolled. The primary end points were the effect of treatment with either barnidipine 10 mg or amlodipine 5 mg once daily on office and ambulatory BP, left ventricular mass index (LVMI), and markers of cardiac damage, serum procollagen type I C-terminal propeptide, and plasma amino-terminal pro-B-type natriuretic peptide concentrations. Patients were assessed at enrollment, and 12 and 24 weeks. During each visit, the prevalence of adverse events (AEs) was also monitored using spontaneous reporting, patient interview, and physical examination, the relationship to study drug being determined by the investigators. Compliance with treatment was assessed at each study visit by counting returned tablets. RESULTS Thirty eligible patients (20 men, 10 women; mean [SD] age, 47 [12] years) were included in the study; all patients completed the 24 weeks of study treatment. Twelve weeks after randomization, 6 patients in the amlodipine group had their dose doubled to 10 mg due to inadequate BP control. Mean BP reductions at study end were not significantly different between the barnidipine and amlodipine groups (office BP, -10.3/-9.4 vs -16.6/-9.1 mm Hg; ambulatory BP, 9.4/6.4 vs 8.1/5.1 mm Hg). Reductions in LVMI and markers of cardiac damage were not significantly different between the 2 groups. Significantly more patients in the amlodipine group reported drug-related AEs compared with those in the barnidipine group (9 [60%] vs 2 [13%]; P < 0.05). CONCLUSION In this small sample of treatment-naive hypertensive patients, the antihypertensive effect of barnidipine 10 mg once daily was not significantly different from that of amlodipine 5 to 10 mg once daily.

Old hypertensive patient: a hard challenge

BACKGROUND High blood pressure is one of the most important cardiovascular risk factor and its incidence is continuously increasing: on 2025 1/3 of adult world population will suffer of it. Moreover, the therapy of elderly hypertension sufferer patient is still growing up in importance for the continuous increase of world population average life. With ageing, the cardiovascular system suffers neurohormonal and haemodinamic modifications which determine the onset of isolate systolic hypertension, which is characteristic of the elderly. This pathology results linked to a higher cardiovascular risk. AIM OF THE STUDY This review aims to analyze and evaluate present and future therapeutic opportunities about anti-hypertensive therapy in elderly people. DISCUSSION AND CONCLUSIONS Also in elderly people systolic blood pressure values must be lower than 150 mmHg, but it’s also important to maintain diastolic pressure not under 70 mmHg, to avoid phenomenons of cerebral and coronary hypo-perfusion (J curve). The benefits of an effective anti-hypertensive therapy are achieved thanks to both blood pressure lowering “per se” and to the decrease of cardiovascular mortality and morbility. Blood pressure control in the elderly is a hard challenge for the low compliance to the therapy, for the importance of the comorbidity and for the supplementary risk factors. ESH-ESC 2007 guidelines recommend for elderly highblood pressure sufferer patient the use first of all of calcium-antagonists and thiazides diuretics, and for second line ACE-inhibitors, ARB and beta-blockers. In several patients combinations of two or more drugs are necessary to obtain pressure control.

Prescription Data Related to the Use of Calcium Channel Blockers, ACE Inhibitors and Angiotensin II Type 1 Receptor Antagonists (Angiotensin Receptor Blockers) in Combination Identify Savings Opportunities

AbstractBackground: It is now recognized that treating hypertension with combination therapy is required to achieve target blood pressure in the majority of patients. Objective: To investigate the use of ACE inhibitors, angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) and calcium channel blockers (CCBs) within the Lombardia Region of Italy and to evaluate associated financial implications of the use of these drugs in free combinations. Methods: Prescription data in the Administrative National Health Service (NHS) Reimbursement Database of the Lombardia Region (2004-6) were analysed for ACE inhibitor, ARB and CCB use. Data included patient code, prescription date, drug class, product license number, number of packs dispensed and actual expenditure reimbursed by the NHS, and were used to calculate the mean daily cost of free combination antihypertensive treatments. Results: ACE inhibitors, ARBs or CCBs were prescribed at least once to 1.6 million patients (17% of Lombardia population) either as single therapy (51.5% of patients receiving these drugs) or in combination therapy (48.5%). Among patients who received these drugs, 22.5% received free combination therapy (primarily ACE inhibitor plus CCB or ARB plus CCB). The mean annual cost for these drugs was h342 million, representing 18% of the total annual pharmaceutical expenditure for the region. Free combinations accounted for 14.3% of treatment days, but 28.3% of annual expenditure for these drugs. Further analysis revealed that the mean expenditure for free combinations was 2.6–31.9% higher than the sum of their individual component costs (mean increase of 5.9% for the most commonly prescribed free combinations). Conclusions: Prescription of free combination of antihypertensive drugs is associated with additional financial burden to the NHS, which may be avoided by prescribing fixed combination therapy.