Recent studies showed that in diabetic hypertensive patients, administration of angiotensin-converting enzyme (ACE)-inhibitors or calcium antagonists can effectively lower blood pressure (BP) and prevent diabetes-related cardiovascular complications with no adverse metabolic effects. We sought to assess the antihypertensive and metabolic effects of the new dihydropyridine calcium antagonist manidipine (M) in patients with diabetes mellitus and essential hypertension as compared with the ACE inhibitor enalapril (E). After 3 weeks of placebo, 101 (62 men; age range, 34-72 years) hypertensives with type IlIdiabetes mellitus were randomized to M 10-20 mg or E 10-20 mg, od. for 74 weeks. At the end of the placebo period and the active-treatment phase, BP was measured with a mercury sphygmomanometer (office, O) and over the 24 h by ambulatory (A) monitoring. ABP recordings were analyzed to obtain 24-h, day (6 a.m. to midnight), and night (midnight to 6 a.m.) average systolic (S) and diastolic (D) BP and heart rate (HR) values. Homogeneity of the antihypertensive effect over the 24 h was assessed by the smoothness index [SI; i.e., the ratio between the average of the 14 hourly BP changes after treatment and the corresponding standard deviation (the higher the SI, the more uniform is the BP control by treatment over the 24 h]. The O SEP and DBP were significantly (p < 0.01) and similarly reduced by M (16 +/- 10 and 13 +/- 6 mm Hg, n = 49) and E (15 +/- 10 and 13 +/- 6 mm Hg, n = 45). The percentage of patients whose O DBP was reduced less than or equal to 85 mm Hg (i.e., the value indicated to be the optimal DBP goal in diabetic hypertensives) was similar for hi (37%) and E (40%). The reduction of 24-h BP also was similar between M (n = 38) and E (n = 38) for bath drugs (systolic, 6 +/- 11 and 8 +/- 10 mm Hg; diastolic, 5 +/- 8 and 5 +/- 7; NS, M vs. E). The antihypertensive effect was distributed in a similar homogeneous fashion throughout the dosing interval, as shown by thr similar SI values (M, 0.6 +/- 1.2 for SBP and 0.6 +/- 0.9 for DBP; E, 0.6 +/- 0.8 for SEP and 0.5 +/- 0.7 for DBP: NS, M vs. E). O and A HR were unchanged by either treatment. Markers of glucose and lipid metabolism and renal function were not significantly modified by treatment both with M and with E. In the diabetic hypertensives, M was as effective and metabolically neutral as the ACE-inhibitor E

Mancia, G., Omboni, S., Agabiti Rosei, E., Casati, R., Fogari, R., Leonetti, G., et al. (2000). Antihypertensive efficacy of manidipine and enalapril in hypertensive diabetic patients. JOURNAL OF CARDIOVASCULAR PHARMACOLOGY, 35(6), 926-931 [10.1097/00005344-200006000-00015].

Antihypertensive efficacy of manidipine and enalapril in hypertensive diabetic patients

MANCIA, GIUSEPPE;
2000

Abstract

Recent studies showed that in diabetic hypertensive patients, administration of angiotensin-converting enzyme (ACE)-inhibitors or calcium antagonists can effectively lower blood pressure (BP) and prevent diabetes-related cardiovascular complications with no adverse metabolic effects. We sought to assess the antihypertensive and metabolic effects of the new dihydropyridine calcium antagonist manidipine (M) in patients with diabetes mellitus and essential hypertension as compared with the ACE inhibitor enalapril (E). After 3 weeks of placebo, 101 (62 men; age range, 34-72 years) hypertensives with type IlIdiabetes mellitus were randomized to M 10-20 mg or E 10-20 mg, od. for 74 weeks. At the end of the placebo period and the active-treatment phase, BP was measured with a mercury sphygmomanometer (office, O) and over the 24 h by ambulatory (A) monitoring. ABP recordings were analyzed to obtain 24-h, day (6 a.m. to midnight), and night (midnight to 6 a.m.) average systolic (S) and diastolic (D) BP and heart rate (HR) values. Homogeneity of the antihypertensive effect over the 24 h was assessed by the smoothness index [SI; i.e., the ratio between the average of the 14 hourly BP changes after treatment and the corresponding standard deviation (the higher the SI, the more uniform is the BP control by treatment over the 24 h]. The O SEP and DBP were significantly (p < 0.01) and similarly reduced by M (16 +/- 10 and 13 +/- 6 mm Hg, n = 49) and E (15 +/- 10 and 13 +/- 6 mm Hg, n = 45). The percentage of patients whose O DBP was reduced less than or equal to 85 mm Hg (i.e., the value indicated to be the optimal DBP goal in diabetic hypertensives) was similar for hi (37%) and E (40%). The reduction of 24-h BP also was similar between M (n = 38) and E (n = 38) for bath drugs (systolic, 6 +/- 11 and 8 +/- 10 mm Hg; diastolic, 5 +/- 8 and 5 +/- 7; NS, M vs. E). The antihypertensive effect was distributed in a similar homogeneous fashion throughout the dosing interval, as shown by thr similar SI values (M, 0.6 +/- 1.2 for SBP and 0.6 +/- 0.9 for DBP; E, 0.6 +/- 0.8 for SEP and 0.5 +/- 0.7 for DBP: NS, M vs. E). O and A HR were unchanged by either treatment. Markers of glucose and lipid metabolism and renal function were not significantly modified by treatment both with M and with E. In the diabetic hypertensives, M was as effective and metabolically neutral as the ACE-inhibitor E
Articolo in rivista - Articolo scientifico
diabetes mellitus; essential hypertension; office blood pressure; ambulatory blood pressure monitoring; manidipine; enalapril
English
2000
35
6
926
931
none
Mancia, G., Omboni, S., Agabiti Rosei, E., Casati, R., Fogari, R., Leonetti, G., et al. (2000). Antihypertensive efficacy of manidipine and enalapril in hypertensive diabetic patients. JOURNAL OF CARDIOVASCULAR PHARMACOLOGY, 35(6), 926-931 [10.1097/00005344-200006000-00015].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/5027
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