Skip to main content

Replacement of Amlodipine and Lercanidipine by Barnidipine: Tolerability and Effectiveness in a Real-Life Study



Hypertension is the leading cause of cardiovascular disease worldwide. Calcium channel blockers are an effective antihypertensive treatment, but frequently hypertension remains uncontrolled for many patients, partly due to tolerability issues.


To assess the tolerability and effectiveness of barnidipine in mild to moderate hypertension patients switching treatment from other calcium channel blockers in daily practice.


BASIC-HT, a prospective real life study, enrolled 20,479 hypertensive patients initiating barnidipine treatment. The present paper focuses on a subgroup of patients in BASIC-HT for whom the previous treatment with amlodipine or lercanidipine was replaced by barnidipine. Tolerability and effectiveness of barnidipine in these patients were assessed at two visits during a 3-month follow up.


In 1710 mild to moderate hypertension patients switching treatment from amlodipine or lercanidipine to barnidipine monotherapy or in combination with other antihypertensive drug classes, mean blood pressure decreased during 3-month follow-up. The mean systolic blood pressure decreased from 153.15 mmHg [95% CI 152.35–153.95] at baseline to 139.20 mmHg [95% CI 138.58–139.82] at visit 3, after 3 months. The mean diastolic blood pressure decreased from 88.85 mmHg at baseline [95% CI 88.36–89.34], to 81.56 mmHg [95% CI 81.20–81.91] at visit 3. Among these patients, 65.4% replaced their initial calcium channel blocker treatment to barnidipine for tolerability reasons. During the follow-up, the main adverse event reported was edema (4.8%). The nature and frequency of events reported in this subgroup of switcher patients were in line with those reported by the total population in BASIC-HT.


This real-life study suggests that replacement of other calcium channel blockers with barnidipine is a valuable therapeutic option, especially when tolerability is an issue.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC 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. 2013;31(7):1281–357.

    Article  CAS  PubMed  Google Scholar 

  2. Statistiques Sanitaires Mondiales 2012. Accessed 26 July 2016.

  3. Turnbull F, Neal B, Ninomiya T, et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ. 2008;336(7653):1121–3.

    Article  CAS  PubMed  Google Scholar 

  4. He J, Whelton PK. Elevated systolic blood pressure and risk of cardiovascular and renal disease: overview of evidence from observational epidemiologic studies and randomized controlled trials. Am Heart J. 1999;138(3 Pt 2):211–9.

    Article  CAS  PubMed  Google Scholar 

  5. Zanchetti A. Antihypertensive therapy: from 2003 to 2013 and beyond. Expert Rev Cardiovasc Ther. 2013;11(11):1443–6.

    Article  CAS  PubMed  Google Scholar 

  6. Mancia G, Parodi A, Merlino L, Corrao G. Heterogeneity in antihypertensive treatment discontinuation between drugs belonging to the same class. J Hypertens. 2011;29:1012–8.

    Article  CAS  PubMed  Google Scholar 

  7. Ruilope LM, Coca A. The role of combination therapy in the treatment of hypertension. Blood Press Suppl. 1998;7:22–6.

    Article  Google Scholar 

  8. Sicca DA. Pharmacotherapy review: calcium channel blockers. J Clin Hypertens (Greenwich). 2006;8(1):53–6.

    Article  Google Scholar 

  9. Opie LH. Pharmacological differences between calcium antagonists. Eur Heart J. 1997;18(Suppl A):71–9.

    Article  Google Scholar 

  10. Paulis L, Steckelings UM, Unger T. Key advances in antihypertensive treatment. Nat Rev Cardiol. 2012;9:276–85.

    Article  CAS  PubMed  Google Scholar 

  11. Weir MR, Rosenberger C, Fink JC. Pilot study to evaluate a water displacement technique to compare effects of diuretics and ACE inhibitors to alleviate lower extremity edema due to dihydropyridine calcium antagonists. Am J Hypertens. 2001;14(9 Pt 1):963–8.

    Article  CAS  PubMed  Google Scholar 

  12. 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;30:330–6.

    Article  CAS  PubMed  Google Scholar 

  13. Hagendorff A, Freytag S, Müller A, Klebs S. Pill burden in hypertensive patients treated with single-pill combination therapy—an observational study. Adv Ther. 2013;30(4):406–9.

    Article  PubMed  Google Scholar 

  14. Korstanje C. Barnidipine, a long-acting slow onset calcium antagonist. Int J Clin Pract Suppl. 2000;114:2–5.

    CAS  Google Scholar 

  15. Malhotra HS, Plosker GL. Barnidipine. Drugs. 2001;61(7):989–96.

    Article  CAS  PubMed  Google Scholar 

  16. Van Zwieten PA. The pharmacological properties of lipophilic calcium antagonists. Blood Press Suppl. 1998;2:5–9.

    Article  PubMed  Google Scholar 

  17. Argenziano L, Izzo R, Iovino G, et al. Distinct vasodilation, without reflex neurohormonal activation, induced by barnidipine in hypertensive patients. Blood Press Suppl. 1998;7:9–14.

    Article  Google Scholar 

  18. 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.

    Article  CAS  PubMed  Google Scholar 

  19. Rossetti G, Pizzocri S, Brasca F, et al. 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. Curr Ther Res Clin Exp. 2008;69(3):192–206.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Zhu W, Li T, Ni C, et al. Comparative study of barnidipine and felodipine in Chinese patients with essential hypertension. J Int Med Res. 2006;34:406–12.

    Article  CAS  PubMed  Google Scholar 

  21. 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;1:27–9.

    Article  PubMed  Google Scholar 

  22. De Giorgio LA, Orlandini F, Malasoma P, Zappa A. Double-blind, crossover study of lercanidipine versus amlodipine in the treatment of mild-to-moderate essential hypertension. Curr Ther Res. 1999;60(10):511–20.

    Article  Google Scholar 

  23. Borghi C. Lercanidipine in hypertension. Vasc Health Risk Manag. 2005;1(3):173–82.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Lins R, Marckx P, Vandebeek R, Vanhoutvinck C, Neuville O. Barnidipine real-life tolerability in arterial hypertension: results from the BASIC-HT study. Acta Clin Belg. 2015;70(4):244–50.

    Article  CAS  PubMed  Google Scholar 

  25. Liau CS. Barnidipine: a new calcium channel blocker for hypertension treatment. Expert Rev Cardiovasc Ther. 2005;3(2):207–13.

    Article  CAS  PubMed  Google Scholar 

  26. Messerli FH. Vasodilatory edema: a common side effect of antihypertensive therapy. Curr Cardiol Rep. 2002;4(6):479–82.

    Article  PubMed  Google Scholar 

  27. Leonetti G, Magnani B, Pessina AC, Rappelli A, Trimarco B, Zanchetti A. Tolerability of long-term treatment with lercanidipine versus amlodipine and lacidipine in elderly hypertensives. Am J Hypertens. 2002;15(11):932–40.

    Article  CAS  PubMed  Google Scholar 

  28. Janssen BJ, Kam KL, Smits JF. Preferential renal and mesenteric vasodilation induced by barnidipine and amlodipine in spontaneously hypertensive rats. Naunyn Schmiedebergs Arch Pharmacol. 2001;364(5):414–21.

    Article  CAS  PubMed  Google Scholar 

  29. Jamerson KA, Nwose O, Jean-Louis L, Schofield L, Purkayastha D, Baron M. Initial angiotensin-converting enzyme inhibitor/calcium channel blocker combination therapy achieves superior blood pressure control compared with calcium channel blocker monotherapy in patients with stage 2 hypertension. Am J Med. 2004;17(6):495–501.

    CAS  Google Scholar 

  30. Makani H, Bangalore S, Romero J, Wever-Pinzon O, Messerli FH. Effect of renin–angiotensin system blockade on calcium channel blocker-associated peripheral edema. Am J Med. 2011;124(2):128–35.

    Article  CAS  PubMed  Google Scholar 

  31. Fogari R, Zoppi A, Derosa G, Mugellini A, Lazzari P, Rinaldi A, Fogari E, Preti P. Effect of valsartan addition to amlodipine on ankle oedema and subcutaneous tissue pressure in hypertensive patients. J Hum Hypertens. 2007;21(3):220–4.

    CAS  PubMed  Google Scholar 

  32. Philipp T, Smith TR, Glazer R, Wernsing M, Yen J, Jin J, Schneider H, Pospiech R. Two multicenter, 8-week, randomized, double-blind, placebo-controlled, parallel-group studies evaluating the efficacy and tolerability of amlodipine and valsartan in combination and as monotherapy in adult patients with mild to moderate essential hypertension. Clin Ther. 2007;29(4):563–80.

    Article  CAS  PubMed  Google Scholar 

  33. Düsing R. Optimizing blood pressure control through the use of fixed combinations. Vasc Health Risk Manag. 2010;6:321–5.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, Mehlsen J. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366(9489):895–906.

    Article  PubMed  Google Scholar 

  35. Jamerson K, Weber MA, Bakris GL, Dahlöf B, Pitt B, Shi V, Velazquez EJ. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008;359(23):2417–28.

    Article  CAS  PubMed  Google Scholar 

  36. Chi C, Tai C, Bai B, Yu S, Karamanou M, Wang J, Xu Y. Angiotensin system blockade combined with calcium channel blockers is superior to other combinations in cardiovascular protection with similar blood pressure reduction: a meta-analysis in 20,451 hypertensive patients. J Clin Hypertens (Greenwich). 2016. doi:10.1111/jch.12771. (Epub ahead of print).

Download references


We would like to thank all the general practitioners who participated in this observational study, DICE NV (Belgium) for the statistical analyses, Marie-Anne Thil and Kirsten Dumaz from Keyrus Biopharma (Belgium) for the publication writing activities.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Robert Lins.

Ethics declarations


The study was sponsored by Fournier Pharma SA, the complementary analyses and manuscript development were sponsored by Astellas Pharma Belgium.

Conflict of interest

Robert Lins received consulting fees from Astellas for revising the original set-up of the protocol, EC submission, revising the original results, interpreting the data and revising the article. Caroline de Vries and Yves Haerden are Astellas employees. The authors did not have other actual or potential competing financial interests.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 20 kb)

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lins, R., Haerden, Y. & de Vries, C. Replacement of Amlodipine and Lercanidipine by Barnidipine: Tolerability and Effectiveness in a Real-Life Study. High Blood Press Cardiovasc Prev 24, 29–36 (2017).

Download citation

  • Published:

  • Issue Date:

  • DOI: