Norvasc (Amlodipine)Norvasc (Amlodipine) 10 mg 100 $173.50
Norvasc (Amlodipine) 5 mg 100 $111.38
Norvasc is the most prescribed medication for getting your blood pressure done according to the Norvasc website
Norvasc website where you can get a lot of information also on Norvasc. such as the common side effects of Norvasc such as swelling in the feet or ankles, headache, feeling tired, or feeling dizzy. The Norvasc website says
"NORVASC relaxes the blood vessels so your heart has less work to do. This means that blood pressure can be lowered and angina pain can be less or controlled."
I am including some of the latest research abstracts on Norvasc which are technical but you might want to show some findings to your doctor if they relate to you. Usually the conclusion on the Norvasc (Amlodipine) are clear.
1: Arterioscler Thromb Vasc Biol. 2003 Dec;23(12):2155-63. Epub 2003 Sep 25. :
Novel vascular biology of third-generation L-type calcium channel antagonists: ancillary actions of amlodipine.
Mason RP, Marche P, Hintze TH.
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, USA.
Calcium channel blockers (CCBs) were developed as vasodilators, and their use in cardiovascular disease treatment remains largely based on that mechanism of action. More recently, with the evolution of second- and third-generation CCBs, pleiotropic effects have been observed, and at least some of CCBs' benefit is attributable to these mechanisms. Understanding these effects has contributed greatly to elucidating disease mechanisms and the rationale for CCB use. Furthermore, this knowledge might clarify why drugs are useful in some disease states, such as atherosclerosis, but not in others, such as heart failure. Although numerous drugs used in the treatment of vascular disease, including statins and angiotensin-converting-enzyme inhibitors, have well-described pleiotropic effects universally accepted to contribute to their benefit, little attention has been paid to CCBs' potentially similar effects. Accumulating evidence that at least 1 CCB, amlodipine, has pharmacologic actions distinct from L-type calcium channel blockade prompted us to investigate the pleiotropic actions of amlodipine and CCBs in general. There are several areas of research; foci here are (1) the physicochemical properties of amlodipine and its interaction with cholesterol and oxidants; (2) the mechanism by which amlodipine regulates NO production and implications; and (3) amlodipine's role in controlling smooth muscle cell proliferation and matrix formation
ACP J Club. 2003 Nov-Dec;139(3):A15; author reply A15. :
Comment on:
ACP J Club. 2003 Jul-Aug;139(1):7.
Amlodipine or lisinopril was not better than chlorthalidone in lowering CHD risk in hypertension.
Heckman GA, Psaty BM.
1: Am J Ther. 2003 Nov-Dec;10(6):409-14. :
Calcium antagonists and atherosclerosis protection in hypertension.
Hernandez RH, Armas-Hernandez MJ, Velasco M, Israili ZH, Armas-Padilla MC.
Clinical Pharmacology Unit, School of Medicine, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, Venezuela.
rhernan@cantv.net
Calcium antagonists are effective in hypertensive patients of all ethnic groups, irrespective of age, dietary salt intake, salt-sensitivity status or plasma renin activity profile. Some prospective studies show that the calcium antagonists, nifedipine GITS and nitrendipine, reduce cardiovascular morbidity and mortality at least to the same extent as the diuretics. Other prospective studies are in progress to evaluate the effect of calcium antagonists on cardiovascular morbidity and mortality, and the progression of atherosclerosis in hypertensive patients. Calcium antagonists, especially the highly lipophilic amlodipine, lacidipine and nisoldipine, are shown to possess antioxidant properties. These drugs reduce the oxidation of LDL and its influx into the arterial wall, and reduce atherosclerotic lesions in animals. Platelet production of malondialdehyde, a marker of oxygen free radical formation, is suppressed by amlodipine, lacidipine or nifedipine in hypertensive patients. New evidence from long-term clinical trials of calcium antagonists indicates that these drugs can reduce the rate of progression of atherosclerosis in hypertensive and coronary heart disease patients. In the Regression Growth Evaluation Statin Study (REGRESS), co-administration of calcium antagonist, amlodipine or nifedipine with pravasatin caused a significant reduction in the appearance of new angiographic lesions. In the Verapamil in Hypertension and Atherosclerosis Study (VHAS), verapamil was more effective than chlorthalidone in promoting regression of thicker carotid lesions in parallel with a reduction in the incidence of cardiovascular events. In the Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT), amlodipine slowed the progression of early coronary atherosclerosis in patients with coronary artery disease. In a subprotocol of the Intervention as a Goal in the Hypertension Treatment (INSIGHT) study, nifedipine GITS significantly decreased intima-media thickness as compared to co-amilozide (hydrochlorothiazide + amiloride). Preliminary results of the European Lacidipine Study on Atherosclerosis (ELSA) show that lacidipine reduced the intima-media thickness progression rate as compared to atenolol. Thus, selective calcium antagonists are potential antiatherosclerotic agents.
J Manag Care Pharm. 2003 Sep-Oct;9(5):424-9. :
Comment in:
J Manag Care Pharm. 2003 Sep-Oct;9(5):454-6.
Patient adherence with amlodipine, lisinopril, or valsartan therapy in a usual-care setting.
Wogen J, Kreilick CA, Livornese RC, Yokoyama K, Frech F.
The Institute for Effectiveness Research, LLC, 520 U.S. Highway 22, Suite 303, Bridgewater, NJ 08807, USA.
OBJECTIVE: To compare the persistence and compliance in a usual-care setting with 3 drugs (amlodipine, lisinopril, or valsartan) from 3 different pharmaceutical classes.calcium-channel blocker, angiotensin-converting enzyme inhibitor, and angiotensin receptor blocker, respectively, commonly used to treat hypertension. METHODS: This retrospective observational study included a cohort of 142,945 continuously benefit-eligible patients from a pharmacy benefit manager drug claims database who began therapy with lisinopril, valsartan, or amlodipine. Concurrent use of other cardiovascular medications was assessed as a proxy for cardiovascular disease severity. Chronic Disease Score (CDS), derived from pharmacy claims data, was used to classify patient chronic disease burden as mild, moderate, or severe. Drug utilization measures included compliance, persistence, medication possession ratio (MPR), duration of therapy, and drug discontinuation. Multiple linear regression techniques were used to assess the impact of various predictor variables on study outcomes and to compare compliance among treatment groups, adjusted for age, gender, and CDS. RESULTS: The mean age of the study cohort was 63.1 years; 53% were female. Just over one half (51%, n=73,148) received amlodipine, 28% (n=40,238) received lisinopril, and 21% (n=29,669) received valsartan. Significantly more valsartan patients (63%) remained persistent on therapy at 12 months past the index date of the first prescription, compared with amlodipine (53%) and lisinopril (50%) patients (P<0.001). Both crude and adjusted compliance rates also were greatest for valsartan patients, reflected by an adjusted mean MPR of 75%, compared with 67% for amlodipine and 65% for lisinopril (P<0.0001, both comparisons). CONCLUSION: These results suggest that, in a usual-care setting, patients receiving valsartan (relative to amlodipine or lisinopril) appear to be more compliant and persistent with pharmacologic therapy, independent of patient chronic disease burden.
1: J Cardiovasc Pharmacol. 2003 Aug;42(2):296-303. :
Amlodipine improves vascular function in patients with moderate to severe hypertension.
Ohtsuka S, Yamazaki A, Oyake Y, Yamaguchi I.
Cardiovascular Division, Department of Internal Medicine, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Ten-noudai, Tsukuba-shi, Ibaraki-ken, 305-8575 Tsukuba, Japan.
otk-sa@md.tsukuba.ac.jpThe long-term effects of amlodipine, a calcium channel blocker, were examined in patients with moderate to severe hypertension. Eighteen never-treated patients with moderate to severe essential hypertension (49 +/- 8 years) were studied. In all patients, forearm blood flow (FBF) was measured by plethysmography before and 6 months after amlodipine treatment. Endothelium-nondependent and endothelium-dependent vasodilations were assessed by intrabrachial infusion of sodium nitroprusside (SNP) and acetylcholine (ACh), respectively. FBF modification by vitamin C, an oxygen radical scavenger, was also assessed under ACh infusion. The results were compared with those of 13 normal subjects. Blood pressure was significantly lowered (from 176 +/- 17/97 +/- 13 to 144 +/- 12/82 +/- 10 mm Hg) after treatment (P < 0.01). Forearm vascular resistance was increased in the hypertensive patients before treatment; however, it was normalized after treatment during SNP infusion and was improved during ACh infusion. Since vitamin C improved FBF under ACh infusion both before and after the amlodipine treatment, it is suggested that the production of free radicals was not canceled by amlodipine. The analysis of heart rate variability showed that amlodipine does not activate sympathetic nerve function. Therefore, amlodipine is effective in lowering blood pressure associated with the improvement of vascular function, and is suggested to be an effective antihypertensive agent for patients with moderate to severe hypertension
1: Mil Med. 2003 Jul;168(7):530-5. :
A comparative analysis of amlodipine and felodipine in a military outpatient population: efficacy, outcomes, and cost considerations.
Blivin SJ, Pippins J, Annis LG, Lyons F.
Department of Primary Care, Naval Medical Clinic, Quantico, VA, USA.
blivin@dellnet.comBACKGROUND: This retrospective study compared the efficacy, tolerability, and cost of two dihydropyridine calcium channel blockers. METHODS: Charts of patients who had been on continuous antihypertensive therapy with amlodipine or felodipine for at least 6 months were reviewed. Analyses include mean changes in blood pressure, percentage of patients achieving blood pressure (BP) < 140/90 mm Hg, average dose, and cost per day of the two calcium channel blockers, average cost of additional medication, total medication cost per day, and cost to achieve BP control. RESULTS: Eighty-seven percent of amlodipine-treated patients achieved BP control compared with 33% of felodipine-treated patients. Total medication cost to achieve BP control was 0.87 dollars per day for patients on amlodipine compared with 1.79 dollars per day for patients on felodipine. CONCLUSIONS: Amlodipine produced BP control in a greater percentage of patients than did felodipine at a lower total cost to achieve BP control. When evaluating the total cost of antihypertensive treatment, the cost of a drug alone can be misleading.
Atherosclerosis. 2003 Jun;168(2):239-44. :
Inhibition of oxidized LDL aggregation with the calcium channel blocker amlodipine: role of electrostatic interactions.
Phillips JE, Preston Mason R.
Department of Medicine, MCP Hahnemann University School of Medicine, Allegheny Campus, Pittsburgh, PA, USA.Atherogenic low-density lipoproteins (LDL) are characterized by elevations in cholesterol content and increased electronegativity, factors that contribute to aggregation and foam cell formation. This study was designed to test the effect of the positively charged calcium channel blocker (CCB) amlodipine on the aggregation properties of oxidized LDL lipids. Large unilamellar vesicles (LUVs) (100 nm diameter) labeled with a non-exchangeable marker [3H]cholesteryl hexadecyl ether were prepared with lipids extracted from human LDL following oxidation. The LUVs were shown to bind, in a reversible fashion, to charged diethylaminoethyl Sephadex columns. The addition of amlodipine inhibited binding of the oxidized LDL lipids in a dose-dependent fashion with an IC(50) in the nanomolar range as a result of its high lipophilicity and positively charged amino group (pK(a) of 9.02). The activity of amlodipine was reproduced in model membranes that contained fixed amounts of charged phospholipid (glycerophospholipid) in a concentration-dependent manner. By contrast, drugs lacking a formal positive charge, including CCBs (felodipine, nifedipine, diltiazem, verapamil) and an angiotensin-converting enzyme-inhibitor (ramiprilate) had no effect on the column binding of the modified, electronegative lipids. These effects of amlodipine on LDL lipid aggregation and electrostatic properties may represent a novel antiatherosclerotic mechanism of action
Nephrol Dial Transplant. 2003 Jun;18(6):1115-21. :
Effect of losartan and amlodipine on proteinuria and transforming growth factor-beta1 in patients with IgA nephropathy.
Park HC, Xu ZG, Choi S, Goo YS, Kang SW, Choi KH, Ha SK, Lee HY, Han DS.
Department of Internal Medicine, College of Medicine, Institute of Kidney Disease, Yonsei University, Seoul, Korea.
BACKGROUND: Transforming growth factor-beta1 (TGF-beta1) is the major profibrotic cytokine involved in many renal diseases, and urinary TGF-beta1 reflects intrarenal TGF-beta1 production. Urinary TGF-beta1 excretion is reported to be significantly increased in patients with immunoglobulin A (IgA) nephropathy. The aim of the present study was to compare the effects of losartan and amlodipine on proteinuria, as well as on serum and urine TGF-beta1 levels in IgA nephropathy patients with hypertension and proteinuria. METHODS: The initial 4 week washout period was followed by 12 weeks of active treatment, in which patients were randomized to once-daily treatment with losartan 50 mg (group 1, n=20) or amlodipine 5 mg (group 2, n=16). Urinary protein and TGF-beta1 excretion, serum TGF-beta1 and other clinical parameters were determined at baseline and during 12 weeks of active treatment. RESULTS: Both treatments controlled blood pressure (BP) to a similar degree, and renal function and other biochemical parameters did not change during the study period. Urinary protein and TGF-beta1 excretions were significantly elevated in IgA nephropathy patients. Losartan significantly reduced urinary protein (from 2.3+/-1.5 g/day at baseline to 1.2+/-1.5 g/day at 12 weeks, P<0.05) and urinary TGF-beta1 excretion (from 31.2+/-14.0 pg/mg creatinine at baseline to 22.1+/-13.5 pg/mg creatinine at 12 weeks, P<0.05). In contrast, amlodipine had no affect on urinary protein and TGF-beta1 excretion. Both losartan and amlodipine failed to reduce serum TGF-beta1 levels. CONCLUSION: Losartan and amlodipine, with similar control of BP, showed different effects on urine protein or TGF-beta1 excretion. Whereas losartan improved both urinary parameters, amlodipine did not. These differences might be important for the management of IgA nephropathy.
Clin Ther. 2003 May;25(5):1469-89. :
Comparison of the blood pressure-lowering effects and tolerability of Losartan- and Amlodipine-based regimens in patients with isolated systolic hypertension.
Volpe M, Junren Z, Maxwell T, Rodriguez A, Gamboa R, Gomez-Fernandez P, Ortega-Gonzalez G, Matadamas N, Rodriguez F, Dass B, Kyle C, Clarysse L, Bryce A, Moreno-Heredia E, Germano G, Gilles L, Smith RD, Sanderson JE; CDSP-944 Study Group.
Universita degli Studi di Roma "La Sapienza", Rome, Italy.
volpe@uniromal.it
BACKGROUND: Elevated systolic blood pressure is a more important risk factor for cardiovascular and renal disease than elevated diastolic blood pressure. Isolated systolic hypertension (ISH) is the predominant form of hypertension in the elderly. Effects of angiotensin II on the vascular wall and endothelium may contribute to development of ISH. OBJECTIVE: The primary objective of this study was to compare the effects on trough sitting systolic blood pressure (SiSBP) of a regimen of losartan, a selective angiotensin II-receptor antagonist, and an amlodipine-based regimen in patients with ISH. METHODS: This multicenter, prospective, randomized, double-blind, parallel-group study consisted of a 4-week placebo phase and an 18-week active-treatment phase. The losartan-based regimen consisted of losartan 50 mg, increased as needed to losartan 50 mg/hydrochlorothiazide (HCTZ) 12.5 mg at week 6 and to losartan 100 mg/HCTZ 25 mg at week 12 to achieve a target SiSBP <140 mm Hg. the amlodipine-based regimen consisted of amlodipine 5 mg, increased as needed to amlodipine 10 mg at week 6 and to amlodipine 10 mg/HCTZ 25 mg at week 12. The primary efficacy measure was change in trough SiSBP from baseline to week 18. Information on the tolerability of study treatments was collected at each visit, including the investigator's and patient's observations of clinical adverse experiences (CAEs), laboratory adverse experiences, and responses to a symptom questionnaire. RESULTS: Eight hundred fifty-seven patients (65.6% female) were randomized to treatment, 432 in the losartan group and 425 in the amlodipine group. Their mean age was 67.6 years, and they had a mean duration of hypertension of 6.7 years at baseline. The losartan and amlodipine groups (intent-to-treat population) had baseline mean SiSBP values of 171.2 and 171.9 mm Hg, respectively. At week 18 (the primary end point), the mean change from baseline in SiSBP was -27.4 mm Hg for 426 patients who received losartan and -28.1 mm Hg for 419 patients who received amlodipine (estimated least-square mean difference, 0.3 mm Hg; 95% CI, -1.4 to 2.0), indicating that losartan's effect on systolic blood pressure was noninferior to that of amlodipine. The proportion of patients who responded (SiSBP <140 mm Hg or a > or =20-mm Hg decrease in SiSBP from baseline) was comparable between groups (73.9% losartan, 75.4% amlodipine). The incidence of CAEs and drug-related CAEs was significantly greater in the amlodipine group (amlodipine, 79.8% and 43.8%, respectively; losartan, 67.8% and 25.5%; P < or = 0.001). In addition, more patients in the amlodipine group discontinued therapy due to a drug-related CAE compared with patients in the losartan group (12.9% vs 4.4%, respectively; P < or = 0.001). Lower-extremity edema was the most common drug-related CAE in the amlodipine group (24.0% amlodipine, 2.5% losartan; P < or = 0.001); dizziness was the most common drug-related CAE in the losartan group (6.0% losartan, 4.0% amlodipine). CONCLUSIONS: In these patients with ISH, losartan and amlodipine produced comparable clinically relevant reductions in SiSBP; however, losartan was better tolerated, as evidenced by fewer CAEs and discontinuations compared with amlodipine. Losartan may be considered for the initial treatment of ISH.
1: Hypertension. 2003 May;41(5):1021-6. Epub 2003 Apr 07.:
Erratum in:
Hypertension. 2003 Dec;42(6):e20.
Effects of the selective aldosterone blocker eplerenone versus the calcium antagonist amlodipine in systolic hypertension.
White WB, Duprez D, St Hillaire R, Krause S, Roniker B, Kuse-Hamilton J, Weber MA.
Section of Hypertension and Clinical Pharmacology, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, Conn 06030-3940, USA.
wwhite @nso1.uchc.edu
Eplerenone is a highly selective aldosterone blocker, which is under development for the treatment of hypertension and heart failure. To assess its usefulness in older patients with systolic hypertension and widened pulse pressure, we compared the effects of eplerenone with amlodipine, on clinic blood pressure (BP) and pulse pressure and in a subset of the patients, ambulatory BP, vascular compliance, and urinary albumin excretion. The study involved 269 patients > or =50 years of age who were randomly assigned to either eplerenone (50 to 200 mg daily) or amlodipine (2.5 to 10 mg daily) in a double-blind titration to effect design. After 24 weeks of therapy, reductions in clinic systolic BP were similar for both treatments (eplerenone, -20.5+/-1.1 mm Hg; amlodipine, -20.1+/-1.1 mm Hg). Reductions in clinic diastolic BP were modestly larger on amlodipine (-6.9+/-0.7 mm Hg) compared with eplerenone (-4.5+/-0.7 mm Hg) (P=0.014). Pulse pressure was also reduced similarly from baseline by the 2 treatment groups (eplerenone, -15.9 mm Hg versus amlodipine, -13.4 mm Hg, P=0.07). Changes from baseline in pulse wave velocity after 24 weeks of therapy were statistically similar for eplerenone and amlodipine. In patients with microalbuminuria at baseline (>30 mg albumin/g creatinine), eplerenone reduced the urinary albumin/creatinine ratio by 52% compared with a reduction of 10% by amlodipine (P=0.04). Thus, eplerenone was as effective as amlodipine in lowering systolic BP and pulse pressure as well as pulse wave velocity in older patients with widened pulse pressure hypertension. Furthermore, eplerenone reduced microalbuminuria to a greater extent than amlodipine in this older patient group.
1: Methods Find Exp Clin Pharmacol. 2003 Apr;25(3):209-13. :
Effect of amlodipine and hormone replacement therapy on blood pressure and bone markers in menopause.
Zacharieva S, Shigarminova R, Nachev E, Kamenov Z, Atanassova I, Orbetzova M, Stoynev A, Doncheva N, Borissova AM.
Clinical Centre of Endocrinology and Gerontology, Medical University, Sofia, Bulgaria.
zacharieva@uheg.medicalnet-bg.org
The aim of this study was to observe the effect of an 8-week treatment with amlodipine, alone or in combination with hormone replacement therapy (HRT), on blood pressure (BP), serum osteocalcin, bone-specific alkaline phosphatase (B-ALP) and urine deoxypiridinoline in postmenopausal osteoporotic women with mild-to-moderate arterial hypertension. Both conventional clinical BP measurements and ambulatory blood pressure monitoring (ABPM) were used. Twenty hypertensive menopausal women with osteoporosis were randomly divided in two groups according to the treatment regimens: amlodipine and amlodipine + HRT. Neither treatment regimen significantly changed bone formation or bone resorption markers. There were no significant differences in levels of serum and urinary calcium and phosphorous or serum cholesterol and low-density lipoprotein (LDL)-cholesterol after treatment with amlodipine alone or in combination with HRT. Triglycerides were significantly decreased and high-density lipoprotein (HDL)-cholesterol was significantly increased after amlodipine treatment. Both treatment regimens significantly decreased conventionally measured BP to a similar extent. Amlodipine given alone lowered the midline estimating statistic of rhythm (MESOR; mean 24-level) of systolic BP and induced phase advances of the circadian rhythms of systolic, diastolic and mean BP. When combined with HRT, amlodipine lowered the MESOR and reduced the amplitude of systolic BP without any phase change. In conclusion, amlodipine is effective in reducing BP in postmenopausal women. The maintenance of a normal circadian BP pattern is also influenced by supplementation with 17beta-estradiol. The 8-week treatment with amlodipine alone and in combination with HRT is not associated with a marked influence on bone metabolism. (c) 2003 Prous Science. All rights reserved.
1: Hypertens Res. 2003 Mar;26(3):201-8. :
Azelnidipine and amlodipine: a comparison of their pharmacokinetics and effects on ambulatory blood pressure.
Kuramoto K, Ichikawa S, Hirai A, Kanada S, Nakachi T, Ogihara T.
Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
kuramoto@tmgh.metro.tokyo.jp
We objected: 1) To compare the effects of azelnidipine and amlodipine on 24-h blood pressure; 2) To monitor the plasma concentration vs. the time profile in order to assess the association between pharmacokinetics and hypotensive activity after administration of either drug for 6 weeks. Blood pressure and pulse rate were measured by 24-h monitoring with a portable automatic monitor in a randomized double-blind study of 46 patients with essential hypertension. Azelnidipine 16 mg (23 patients) or amlodipine 5 mg (23 patients) was administered once daily for 6 weeks. Pharmacokinetics were analyzed after the last dose was taken. Both drugs showed similar effects on the office blood pressure and pulse rate. During 24-h monitoring, both drugs caused a decrease in systolic blood pressure of 13 mmHg and had a similar hypotensive profile during the daytime period (07:00-21:30). The pulse rate decreased by 2 beats/min in the azelnidipine group, whereas it significantly increased by 4 beats/min in the amlodipine group. Similar trends in the blood pressure and pulse rate were observed during the nighttime (22:00-6:30) and over 24 h. Excessive blood pressure reduction during the nighttime was not seen in either group. The pharmacokinetic results indicated that the plasma half-life (t1/2) of amlodipine was 38.5 +/- 19.8 h and that of azelnidipine was 8.68 +/- 1.33 h. Despite this difference in pharmacokinetics, the hypotensive effects of amlodipine and azelnidipine were similar throughout the 24-h administration period.
1: Am J Cardiol. 2003 Feb 1;91(3):274-9. :
Comparison of effects of nisoldipine-extended release and amlodipine in patients with systemic hypertension and chronic stable angina pectoris.
Pepine CJ, Cooper-DeHoff RM, Weiss RJ, Koren M, Bittar N, Thadani U, Minkwitz MC, Michelson EL, Hutchinson HG; Comparative Efficacy and Safety of Nisoldipine and Amlodipine (CESNA-II) Study Investigators.
University of Florida College of Medicine, Gainesville, Florida 32610, USA.The efficacy and safety of nisoldipine-extended release (ER) and amlodipine were compared in a 6-week multicenter, randomized, double-blind, double-dummy, parallel group, titration-to-effect trial in patients with stage 1 to 2 systemic hypertension (90 to 109 mm Hg diastolic blood pressure [BP]) and chronic stable angina pectoris. After a 3-week placebo run-in period, patients (n = 120) were randomly assigned to active treatment with either nisoldipine-ER (20 to 40 mg) or amlodipine (5 to 10 mg) once daily, titrated as necessary after 2 weeks to achieve diastolic BP <90 mm Hg. After 6 weeks, the mean reduction in systolic/diastolic BP from baseline was 15/13 mm Hg with nisoldipine-ER and 13/11 mm Hg with amlodipine (p = NS/p = NS). Both drugs resulted in similar BP responder rates (diastolic BP <90 mm Hg in 87% of patients who received nisoldipine-ER and 78% of patients on amlodipine, p = NS) and anti-ischemic responder rates (increasing exercise time >20% in 20% and 27%, respectively [p = NS], and increasing exercise time >60 seconds in 32% and 29% of patients, respectively [p = NS]. Also, after 6 weeks of active therapy, there was a similar mean increase in total exercise duration (23 seconds in the nisoldipine-ER group and 21 seconds in the amlodipine group, p = NS). Neither drug increased heart rate and both decreased frequency of anginal episodes. Adverse events were infrequent, and typically were vasodilator-related effects (including headache and peripheral edema) that occurred with somewhat higher incidence in the nisoldipine-ER group. Thus, nisoldipine-ER and amlodipine provided comparable antihypertensive and anti-ischemic efficacy, and both were generally well tolerated.
