Outcomes with nifedipine GITS or Co-amilozide in hypertensive diabetics and nondiabetics in Intervention as a Goal in Hypertension (INSIGHT).

Abstract

To investigate the impact of treatment on cardiovascular mortality and morbidity, we assessed outcomes in patients with hypertension and diabetes who received co-amilozide or nifedipine in the International Nifedipine GITS Study: Intervention as a Goal in Hypertension. Participants had to be 55 to 80 years of age, with hypertension (> or =150/95 or > or =160 mm Hg) and at least one additional cardiovascular risk factor. Patients received 30 mg nifedipine once daily or co-amilozide (25 mg hydrochlorothiazide and 2.5 mg amiloride) daily. Doses were doubled if target blood pressures (<140/90 mm Hg) were not achieved. Primary (composite of cardiovascular death, myocardial infarction, heart failure, and stroke) and secondary outcomes (composite of primary outcomes, including all-cause mortality and death from vascular and nonvascular causes) were assessed by means of intent-to-treat analyses. There was no significant difference in the incidence of primary outcomes between nifedipine-treated and co-amilozide-treated patients with diabetes at baseline (n=1302) (8.3% versus 8.4%; relative risk, 0.99, 95% CI, 0.69 to 1.42; P=1.00). A significant benefit for nifedipine-treated patients was seen for the composite secondary outcome (14.2% versus 18.7%; relative risk, 0.76, 95% CI, 0.59 to 0.97; P=0.03). Among patients without diabetes at baseline (n=5019), there was a significant difference in the incidence of new diabetes (nifedipine 4.3% versus co-amilozide 5.6%, P=0.023). Nifedipine GITS once daily is as effective as diuretic therapy in reducing cardiovascular complications in hypertensive diabetics. Nifedipine-treated patients were also less likely to have diabetes or have secondary events (a composite of all-cause mortality, death from a vascular cause, and death from a nonvascular cause) than co-amilozide recipients. Our results suggest that nifedipine could be considered as first-line therapy for hypertensive diabetics.

• Authors: Giuseppe Mancia, Morris Brown, Alain Castaigne, Peter de Leeuw, Christopher R Palmer, Talma Rosenthal, Gilbert Wagener, Luis M Ruilope, INSIGHT
• Journal: Hypertension (Dallas, Tex. : 1979) (Hypertension) Vol. 41 Issue 3 Pg. 431-6 (Mar 2003) ISSN: 1524-4563 [Electronic] United States
• PMID: 12623939 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents
• Calcium Channel Blockers
• Diuretics
• Drug Combinations
• Hydrochlorothiazide
• amiloride, hydrochlorothiazide drug combination
• Amiloride
• Nifedipine

Topics

• Aged
• Amiloride (therapeutic use)
• Antihypertensive Agents (therapeutic use)
• Blood Pressure (drug effects)
• Calcium Channel Blockers (therapeutic use)
• Cardiovascular Diseases (mortality, prevention & control)
• Diabetes Complications
• Diabetes Mellitus (epidemiology)
• Diuretics (therapeutic use)
• Drug Combinations
• Female
• Heart Rate (drug effects)
• Humans
• Hydrochlorothiazide (therapeutic use)
• Hypertension (complications, drug therapy, physiopathology)
• Incidence
• Male
• Middle Aged
• Nifedipine (therapeutic use)
• Organizational Objectives
• Treatment Outcome