Key result
Azelnidipine significantly decreased morning pulse rate at home by 6.4 beats/min compared to a non-significant 2.1 beats/min reduction with amlodipine, while both drugs achieved similar reductions in morning blood pressure.
Why the study?
Does azelnidipine improve home morning blood pressure and pulse rate compared to amlodipine in outpatients with essential hypertension?
RCT (n=108)
Single-blind
Randomized
No
Does azelnidipine improve home morning blood pressure and pulse rate compared to amlodipine in outpatients with essential hypertension?
Absolute Event Rate: -6.4% vs -2.1%
p-value: p=<0.01
Azelnidipine effectively lowers morning blood pressure similarly to amlodipine but provides the additional benefit of reducing home pulse rate in patients with essential hypertension.
May favor azelnidipine when morning heart rate reduction is also desired; extends comparative evidence on dihydropyridine CCB effects.
Recently it has been recognized that not only blood pressure (BP) but also pulse rate (PR) assessed in the setting of the patient's home by a home BP monitoring device has higher predictive power for cardiovascular events than similar measurements made in the office setting. In this study, we compared the efficacy of azelnidipine to that of amlodipine in lowering morning BP and reducing PR in outpatients with essential hypertension. Patients were assigned to receive once daily administration of azelnidipine 8-16 mg/day (n = 54) or amlodipine 2.5-5 mg/day (n = 54) for 8 weeks. Morning BP and PR were evaluated by assessing patients' self-monitored BP and PR in the home environment. The mean reductions of morning systolic/diastolic BP (SBP/DBP) in the azelnidipine and amlodipine groups were similar (-24.1 +/- 11.8/-14.1 +/- 10.7 vs. -20.4 +/- 11.7/-12.2 +/- 7.7 mmHg). However, whereas azelnidipine decreased mean PR by -6.4 +/- 8.3 beats/min (p < 0.05 vs. baseline), amlodipine did not cause significant reduction of this parameter (-2.1 +/- 8.2 beats/min). Although neither drug changed PR in patients in whom baseline PR was < 70 beats/min, azelnidipine significantly lowered PR in patients whose baseline PR was > 70 beats/min. These results suggest that oral azelnidipine administration may be an effective therapy in the setting of chronic morning hypertension as well as for home PR control.
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Toshio Yamagishi (2006) conducted an RCT in Essential hypertension (n=108). Azelnidipine vs. Amlodipine (2.5-5 mg/day) was evaluated on Mean reduction in morning pulse rate at home (beats/min) (p=<0.01). Azelnidipine significantly decreased morning pulse rate at home by 6.4 beats/min compared to a non-significant 2.1 beats/min reduction with amlodipine, while both drugs achieved similar reductions in morning blood pressure.
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