First-Step Treatment of Mild to Moderate Uncomplicated Essential Hypertension by a New Calcium Antagonist: Nicardipine

Abstract

Nicardipine, a new calcium antagonist, was tested in a 14-week double-blind trial including 105 outpatients with uncomplicated essential hypertension. They were randomly assigned to nicardipine (20-30 mg three times daily) or placebo as first-step treatment. When necessary but always after a minimum of 4 weeks, pindolol (15 mg/day) was combined with nicardipine or placebo. At the end of step 1 (85 .+-. 6 days with nicardipine vs. 58 .+-. 6 days with placebo, p < 0.01), nicardipine induced larger drops in supine systolic and diastolic blood pressure (SBP and DBP) than the placebo (21 .+-. 2.5 vs. 1.4 .+-. 3 mm Hg, p < 0.001, and 13 .+-. 2 vs. 3.5 .+-. 1.5 mm Hg, P < 0.001, respectively). In the nicardipine group (n = 57), 53% of patients had controlled blood pressure (SBP < 160 mm Hg and DBP < 95 mm Hg) versus 17% in the placebo group (n = 47), p < 0.001. There was no significant correlation between the decrease in blood pressure and the age of patients. The most common side effects in the nicardipine group were flushes (12%), headache (8%), ankle edema (5%), and asthenia (4%). When blood pressure was not brought under control and pindolol was prescribed as the second-step treatment, the nicardipine group (n = 52) displayed larger drops in SBP and DBP than the placebo group (n = 40) (27 .+-. 5 vs. 15 .+-. 3 mm Hg, p < 0.01, and 18 .+-. 1 vs. 9 .+-. 2 mm Hg, p < 0.001, respectively). These results show that a calcium antagonist is useful for first-step treatment of hypertension.