Key result
Amlodipine and nifedipine-GITS similarly reduced 24-hour systolic BP (10.3 vs 10.9 mm Hg; P≥0.24) at 8 weeks, though amlodipine maintained greater BP reduction after a missed dose.
Why the study?
It was unknown whether the long half-time dihydropyridine calcium channel blocker amlodipine was more efficacious than nifedipine-GITS in lowering ambulatory BP in sustained hypertension.
Does amlodipine improve ambulatory blood pressure reduction compared to nifedipine-GITS in patients with sustained hypertension, particularly when a dose is missed?
RCT (n=505)
randomly assigned
Yes
Does amlodipine improve ambulatory blood pressure reduction compared to nifedipine-GITS in patients with sustained hypertension, particularly when a dose is missed?
Absolute Event Rate: 10.3% vs 10.9%
p-value: p=≥ 0.24
Amlodipine and nifedipine-GITS are similarly effective for daily BP control, but amlodipine provides better sustained BP lowering when a dose is missed.
Amlodipine may be preferred with imperfect adherence; extends RCT evidence on missed-dose BP control versus nifedipine-GITS.
In a multicenter, randomized trial, we investigated whether the long half-time dihydropyridine calcium channel blocker amlodipine was more efficacious than the gastrointestinal therapeutic system (GITS) formulation of nifedipine in lowering ambulatory blood pressure (BP) in sustained hypertension (clinic systolic/diastolic BP 140-179/90-109 mm Hg and 24-hour systolic/diastolic BP ≥ 130/80 mm Hg). Eligible patients were randomly assigned to amlodipine 5-10 mg/day or nifedipine-GITS 30-60 mg/day. Ambulatory BP monitoring was performed for 24 hours at baseline and 4-week treatment and for 48 hours at 8-week treatment with a dose of medication missed on the second day. After 8-week treatment, BP was similarly reduced in the amlodipine (n = 257) and nifedipine-GITS groups (n = 248) for both clinic and ambulatory (24-hour systolic/diastolic BP 10.3/6.5 vs 10.9/6.3 mm Hg, P ≥ 0.24) measurements. However, after missing a dose of medication, ambulatory BP reductions were greater in the amlodipine than nifedipine-GITS group, with a significant (P ≤ 0.04) between-group difference in 24-hour (-1.2 mm Hg) and daytime diastolic BP (-1.5 mm Hg). In conclusion, amlodipine and nifedipine-GITS were efficacious in reducing 24-hour BP. When a dose of medication was missed, amlodipine became more efficacious than nifedipine-GITS.
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Huang et al. (2019) conducted an RCT in sustained hypertension (n=505). Amlodipine vs. Nifedipine-GITS 30-60 mg/day was evaluated on Reduction in 24-hour systolic blood pressure (p=≥ 0.24). Amlodipine and nifedipine-GITS similarly reduced 24-hour systolic BP (10.3 vs 10.9 mm Hg; P≥0.24) at 8 weeks, though amlodipine maintained greater BP reduction after a missed dose.
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