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Current Therapeutic Research, Clinical and Experimental logoLink to Current Therapeutic Research, Clinical and Experimental
. 2008 Jun;69(3):192–206. doi: 10.1016/j.curtheres.2008.06.002

Antihypertensive effect of barnidipine 10 mg or amlodipine 5 to 10 mg once daily in treatment-naive patients with essential hypertension: A 24-week, randomized, open-label, pilot study

Giuseppe Rossetti 1, Samuele Pizzocri 1, Francesco Brasca 1, Marta Pozzi 1, Laura M Beltrami 1, Giovanni B Bolla 2, Roberta Famiani 1, Barbara Caimi 1, Stefano Omboni 3, Fabio Magrini 2, Stefano Carugo 1,a
PMCID: PMC3969966  PMID: 24692798

Abstract

Background: Dihydropyridine calcium antagonists are largely employed for the treatment of hypertension, coronary heart disease, and heart failure.

Objective: The aim of our study was to compare the antihypertensive effect of the dihydropyridine calcium antagonists barnidipine and amlodipine.

Methods: This was a 24-week, randomized, open-label, pilot study. Consecutive treatment-naive patients with grade I or II essential hypertension (office sitting systolic blood pressure [BP] of 140–179 mm Hg and diastolic BP of 90–109 mm Hg) were enrolled. The primary end points were the effect of treatment with either barnidipine 10 mg or amlodipine 5 mg once daily on office and ambulatory BP, left ventricular mass index (LVMI), and markers of cardiac damage, serum procollagen type I C-terminal propeptide, and plasma amino-terminal pro-B-type natriuretic peptide concentrations. Patients were assessed at enrollment, and 12 and 24 weeks. During each visit, the prevalence of adverse events (AEs) was also monitored using spontaneous reporting, patient interview, and physical examination, the relationship to study drug being determined by the investigators. Compliance with treatment was assessed at each study visit by counting returned tablets.

Results: Thirty eligible patients (20 men, 10 women; mean [SD] age, 47 [12] years) were included in the study; all patients completed the 24 weeks of study treatment. Twelve weeks after randomization, 6 patients in the amlodipine group had their dose doubled to 10 mg due to inadequate BP control. Mean BP reductions at study end were not significantly different between the barnidipine and amlodipine groups (office BP, −10.3/−9.4 vs −16.6/−9.1 mm Hg; ambulatory BP, 9.4/6.4 vs 8.1/5.1 mm Hg). Reductions in LVMI and markers of cardiac damage were not significantly different between the 2 groups. Significantly more patients in the amlodipine group reported drug-related AEs compared with those in the barnidipine group (9 [60%] vs 2 [13%]; P < 0.05).

Conclusion: In this small sample of treatment-naive hypertensive patients, the antihypertensive effect of barnidipine 10 mg once daily was not significantly different from that of amlodipine 5 to 10 mg once daily.

Key Words: essential hypertension, ambulatory bloodpressure monitoring, barnidipine, amlodipine, left ventricular mass index, smoothness index

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References

  • 1.Guidelines Subcommittee of the World Health Organization-International Society of Hypertension (WHO-ISH) 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. J Hypertens. 1999;17:151–183. [PubMed] [Google Scholar]
  • 2.Chobanian AV, Bakris GL, Black HR, National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National High Blood Pressure Education Program Coordinating Committee The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA. 2003;289:2560–2572. doi: 10.1001/jama.289.19.2560. [published correction appears in JAMA. 2003;290:197] [DOI] [PubMed] [Google Scholar]
  • 3.Mancia G, De Backer G, Dominiczak A, Task Force for the Management of Arterial Hypertension of the European Society of Hypertension and of the European Society of Cardiology 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) J Hypertens. 2007;25:1105–1187. doi: 10.1097/HJH.0b013e3281fc975a. [published correction appears in J Hypertens. 2007;25:1749] [DOI] [PubMed] [Google Scholar]
  • 4.Chen K, Chiou CF, Plauschinat CA. Patient satisfaction with antihypertensive therapy. J Hum Hypertens. 2005;19:793–799. doi: 10.1038/sj.jhh.1001899. [DOI] [PubMed] [Google Scholar]
  • 5.Erkens JA, Panneman MM, Klungel OH. Differences in antihypertensive drug persistence associated with drug class and gender: A PHARMO study. Pharmacoepidemiol Drug Saf. 2005;14:795–803. doi: 10.1002/pds.1156. [DOI] [PubMed] [Google Scholar]
  • 6.Liau CS. Barnidipine: A new calcium channel blocker for hypertension treatment. Expert Rev Cardiovasc Ther. 2005;3:207–213. doi: 10.1586/14779072.3.2.207. [DOI] [PubMed] [Google Scholar]
  • 7.Malhotra HS, Plosker GL. Barnidipine. Drugs. 2001;61:989–996. doi: 10.2165/00003495-200161070-00007. [DOI] [PubMed] [Google Scholar]
  • 8.Hart W, Holwerda NJ, Dutch Barnidipine Multicenter Study Group Barnidipine, a novel calcium antagonist for once-daily treatment of hypertension: A multicenter, double-blind, placebo-controlled, dose-ranging study. Cardiovasc Drugs Ther. 1997;11:637–643. doi: 10.1023/a:1007778706354. [DOI] [PubMed] [Google Scholar]
  • 9.Ohya Y, Abe I, Ohta Y. Natriuretic effect of barnidipine, a long-acting dihydropyridine calcium channel blocker, in patients with essential hypertension. Int J Clin Pharmacol Ther. 2000;38:304–308. doi: 10.5414/cpp38304. [DOI] [PubMed] [Google Scholar]
  • 10.Naber FB, Häge R, Mortelmans J. Barnidipine monotherapy and combination therapy in older patients with essential hypertension: A long-term study. Int J Clin Pract Suppl. 2000;114:27–35. [PubMed] [Google Scholar]
  • 11.Smilde JG. The long-term efficacy and safety profile of barnidipine. Int J Clin Pract Suppl. 2000;114:20–26. [PubMed] [Google Scholar]
  • 12.Zhu W, Li T, Ni C. Comparative study of barnidipine and felodipine in Chinese patients with essential hypertension. J Int Med Res. 2006;34:406–412. doi: 10.1177/147323000603400410. [DOI] [PubMed] [Google Scholar]
  • 13.Liau CS, Chien KL, Chao CL, Lee TM. Efficacy and safety of barnidipine compared with felodipine in the treatment of hypertension in Chinese patients. J Int Med Res. 2002;30:330–336. doi: 10.1177/147323000203000317. [DOI] [PubMed] [Google Scholar]
  • 14.Spieker C. Efficacy and tolerability of once-daily barnidipine in the clinical management of patients with mild to moderate essential hypertension. Blood Press Suppl. 1998;1:15–21. doi: 10.1080/080370598438555. [DOI] [PubMed] [Google Scholar]
  • 15.Ruilope LM, Coca A. The role of combination therapy in the treatment of hypertension. Blood Press Suppl. 1998;1:22–26. doi: 10.1080/080370598438564. [DOI] [PubMed] [Google Scholar]
  • 16.Otterstad JE, Ruilope LM. Treatment of hypertension in the very old. Int J Clin Pract Suppl. 2000;114:10–19. [PubMed] [Google Scholar]
  • 17.Buranakitjaroen P, Koanantakul B, Phoojaroenchanachai M, Chawantanpipat C. The efficacy and tolerability of barnidipine hydrochloride in Thai patients with hypertension. J Int Med Res. 2004;32:185–200. doi: 10.1177/147323000403200212. [DOI] [PubMed] [Google Scholar]
  • 18.Imai Y, Abe K, Nishiyama A, Barnidipine Study Group Evaluation of the antihypertensive effect of barnidipine, a dihydropyridine calcium entry blocker, as determined by the ambulatory blood pressure level averaged for 24 h, daytime, and nighttime. Am J Hypertens. 1997;10:1415–1419. doi: 10.1016/s0895-7061(97)00361-0. [DOI] [PubMed] [Google Scholar]
  • 19.Gottdiener JS, Bednarz J, Devereux R, American Society of Echocardiography American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr. 2004;17:1086–1119. doi: 10.1016/j.echo.2004.07.013. [DOI] [PubMed] [Google Scholar]
  • 20.Devereux RB, Lutas EM, Casale PN. Standardization of M-mode echocardiographic left ventricular anatomic measurements. J Am Coll Cardiol. 1984;4:1222–1230. doi: 10.1016/s0735-1097(84)80141-2. [DOI] [PubMed] [Google Scholar]
  • 21.Dubois D, Dubois EF. Clinical calorimetry. A formula to estimate the approximate surface mass if height and weight are known. Arch Intern Med. 1916;17:863–871. [Google Scholar]
  • 22.Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977;55:613–618. doi: 10.1161/01.cir.55.4.613. [DOI] [PubMed] [Google Scholar]
  • 23.Parati G, Bosi S, Castellano M. Guidelines for 24h non-invasive ambulatory blood pressure monitoring. Report from a working group of the Italian Society of Hypertension. High Blood Press. 1995;4:168–174. [Google Scholar]
  • 24.Rizzoni D, Castellano M, Muiesan ML. Beyond trough:peak ratio: A new index of the smoothness of the antihypertensive effect of a drug. High Blood Press. 1997;6:110–115. [Google Scholar]
  • 25.Parati G, Omboni S, Rizzoni D. The smoothness index: A new, reproducible and clinically relevant measure of the homogeneity of the blood pressure reduction with treatment for hypertension. J Hypertens. 1998;16:1685–1691. doi: 10.1097/00004872-199816110-00016. [DOI] [PubMed] [Google Scholar]
  • 26.Omboni S, Parati G, Mancia G. The trough:peak ratio and the smoothness index in the evaluation of control of 24h blood pressure by treatment in hypertension. Blood Press Monit. 1998;3:201–204. [PubMed] [Google Scholar]
  • 27.Rizzoni D, Muiesan ML, Salvetti M. The smoothness index, but not the trough-to-peak ratio predicts changes in carotid artery wall thickness during antihypertensive treatment. J Hypertens. 2001;19:703–711. doi: 10.1097/00004872-200104000-00007. [DOI] [PubMed] [Google Scholar]
  • 28.van der Velden JW, Beudeker HJ, Nishi M. Diversity and intensity of adverse events in the treatment of hypertension with barnidipine. Blood Press Suppl. 1998;1:27–29. doi: 10.1080/080370598438573. [DOI] [PubMed] [Google Scholar]
  • 29.Beudeker HJ, van der Velden JW, van der Aar EM. Interaction profile and tolerability of barnidipine. Int J Clin Prac Suppl. 2000;114:36–40. [PubMed] [Google Scholar]
  • 30.Benetos A, Rudnichi A, Safar M, Guize L. Pulse pressure and cardiovascular mortality in normotensive and hypertensive subjects. Hypertension. 1998;32:560–564. doi: 10.1161/01.hyp.32.3.560. [DOI] [PubMed] [Google Scholar]
  • 31.Millar JA, Lever AF, Burke V. Pulse pressure as a risk factor for cardiovascular events in the MRC Mild Hypertension Trial. J Hypertens. 1999;17:1065–1072. doi: 10.1097/00004872-199917080-00004. [DOI] [PubMed] [Google Scholar]
  • 32.Kannel WB, Kannel C, Paffenbarger RS, Jr, Cupples LA. Heart rate and cardiovascular mortality: The Framingham Study. Am Heart J. 1987;113:1489–1494. doi: 10.1016/0002-8703(87)90666-1. [DOI] [PubMed] [Google Scholar]
  • 33.Argenziano L, Izzo R, Iovino G. Distinct vasodilation, without reflex neurohormonal activation, induced by barnidipine in hypertensive patients. Blood Press Suppl. 1998;7:9–14. doi: 10.1080/080370598438546. [DOI] [PubMed] [Google Scholar]
  • 34.López B, González A, Varo N. Biochemical assessment of myocardial fibrosis in hypertensive heart disease. Hypertension. 2001;38:1222–1226. doi: 10.1161/hy1101.098549. [DOI] [PubMed] [Google Scholar]
  • 35.Costello-Boerrigter LC, Boerrigter G, Redfield MM. Amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in the general community: Determinants and detection of left ventricular dysfunction. J Am Coll Cardiol. 2006;47:345–353. doi: 10.1016/j.jacc.2005.09.025. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.van Zwieten PA. Pharmacological profile of barnidipine: A single optical isomer dihydropyridine calcium antagonist. Blood Press Suppl. 1998;7:5–8. [PubMed] [Google Scholar]
  • 37.Hattori Y, Kasai K, So S. Effects of calcium channel antagonists on the induction of nitric oxide synthase in cultured cells by immunostimulants. Life Sci. 1995;57:1833–1840. doi: 10.1016/0024-3205(95)02163-d. [DOI] [PubMed] [Google Scholar]
  • 38.Mancia G, Omboni S, Parati G. Lack of placebo effect on ambulatory blood pressure. Am J Hypertens. 1995;8:311–315. doi: 10.1016/0895-7061(94)00250-F. [DOI] [PubMed] [Google Scholar]
  • 39.Dupont AG, Van der Niepen P, Six RO. Placebo does not lower ambulatory blood pressure. Br J Clin Pharmacol. 1987;24:106–109. doi: 10.1111/j.1365-2125.1987.tb03145.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Trazzi S, Mutti E, Frattola A. Reproducibility of non-invasive and intra-arterial blood pressure monitoring: Implications for studies on antihypertensive treatment. J Hypertens. 1991;9:115–119. doi: 10.1097/00004872-199102000-00003. [DOI] [PubMed] [Google Scholar]

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