Key result
Titrating amlodipine from 5 mg to 10 mg in diabetic hypertensive patients significantly reduced systolic blood pressure by 12.5 mmHg (95% CI -15.5 to -9.5; P<0.0001), similar to non-diabetics.
Why the study?
Does uptitrating amlodipine from 5 mg to 10 mg reduce blood pressure in diabetic patients with hypertension?
Does uptitrating amlodipine from 5 mg to 10 mg reduce blood pressure in diabetic patients with hypertension?
Mean Difference: -12.5 (95% CI -15.5–-9.5)
p-value: p=<0.0001
Uptitrating amlodipine from 5 mg to 10 mg provides significant and comparable blood pressure reductions in both diabetic and non-diabetic hypertensive patients.
Supports uptitration of amlodipine to 10 mg for BP control in diabetic hypertension; confirms comparable efficacy versus non-diabetics.
Diabetic patients with hypertension are approximately twice as likely to develop cardiovascular disease as non-diabetic patients with hypertension. Given that hypertension affects ∼60% of patients with diabetes, effective blood pressure (BP) management is important in this high-risk population. This post-hoc analysis pooled data from six clinical studies to quantify additional BP efficacy achieved when titrating hypertensive diabetic patients from amlodipine 5 mg to 10 mg. Approximately half of the diabetic patients were male (44/98; 44.9%) with a mean (standard deviation [SD]) age of 60.6 (9.6) years and a baseline mean (standard error [SE]) systolic blood pressure/diastolic blood pressure (SBP/DBP) of 150.8 (1.30)/87.5 (0.94) mmHg while on amlodipine 5 mg (159.1 [1.40]/92.6 [0.94] mmHg prior to treatment). In comparison, 350/610 (57.4%) non-diabetic patients were male with a mean (SD) age of 58.7 (11.1) years and baseline mean (SE) SBP/DBP of 150.3 (0.62)/90.9 (0.41) mmHg while on amlodipine 5 mg (160.0 [0.67]/96.2 [0.45] mmHg prior to treatment). Increasing amlodipine from 5 mg to 10 mg lowered sitting SBP by -12.5 mmHg (95% confidence interval (CI): -15.5, -9.5; P<0.0001) and DBP by -6.0 mmHg (-7.4, -4.6; P<0.0001) in diabetic patients; and SBP by -12.4 mmHg (-13.5, -11.3; P<0.0001) and DBP by -7.3 mmHg (-8.0, -6.7; P<0.0001) in non-diabetic patients. In total, 12.0% (95% CI: 6.4, 20.0) of diabetic patients achieved their BP goal versus 46.4% (42.4, 50.4) of non-diabetic patients after titration to amlodipine 10 mg. Overall, 22.0% of diabetic patients experienced 31 adverse events (AEs) and 28.9% of non-diabetic patients experienced 282 AEs. Serious AEs were reported by one (1.0%) diabetic and five (0.8%) non-diabetic patients. In this analysis, increasing amlodipine from 5 mg to 10 mg produced a clinically significant reduction in the BP of diabetic hypertensive patients, similar to non-diabetic patients, highlighting the importance of optimizing amlodipine titration in this high-risk population.
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Jeffers et al. (2014) studied Hypertension in diabetic and non-diabetic patients (n=708). Amlodipine titration vs. Baseline (amlodipine 5 mg) was evaluated on Reduction in sitting systolic blood pressure in diabetic patients (MD -12.5 mmHg, 95% CI -15.5, -9.5, p=<0.0001). Titrating amlodipine from 5 mg to 10 mg in diabetic hypertensive patients significantly reduced systolic blood pressure by 12.5 mmHg (95% CI -15.5 to -9.5; P<0.0001), similar to non-diabetics.
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