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Morning versus evening administration of nifedipine gastrointestinal therapeutic system in the management of essential hypertension

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Abstract

The nifedipine gastrointestinal therapeutic system (GITS) is a recently developed controlled-release formulation for once-a-day dosing. We evaluated the influence of morning versus evening administration of the drug in a randomized double-blind cross-over study including 15 essential hypertensives. Five patients had to be excluded from blood pressure analysis because of noncompliance (three cases) or intolerable side effects (two cases). To assess the exact duration of the antihypertensive efficacy noninvasive automatic ambulatory blood pressure monitoring was performed. After a placebo period patients were given 30 mg nifedipine GITS either at 1000 or 2200 hours. Twenty-four-hour systolic and diastolic blood pressure profiles documented a sustained antihypertensive effect of both nifedipine regimens throughout the whole period without affecting the circadian rhythm. Statistical analysis revealed no significant difference between morning and evening administration. Two patients stopped their medication because of intolerable side effects (fatigue and muscle cramps, respectively). Two more cases suffered from mild reversible headache which provoked no discontinuation of the drug. In conclusion our results document a sustained antihypertensive efficacy of 30 mg nifedipine GITS in patients with moderate essential hypertension. Time of administration has no impact on day- and nighttime blood pressure control.

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Abbreviations

GITS:

gastrointestinal therapeutic system

References

  1. Agnoli A, Manfredi M, Mossuto L, Picinelli A (1975) Relationship between circadian rhythms and blood pressure and the pathogenesis of cerebrovascular insufficiency. Rev Neurol 131:597–606

    Google Scholar 

  2. Carr AA, Bottini PB, Feig P, Prisant LM, Mulligan S, Devane JG, Fisher L, Rhoades RB, MacCarthy EP (1992) Effectiveness of once-daily monotherapy with a new nifedipine sustained release calcium antagonist. Am J Cardiol 69:28E-32E

    Google Scholar 

  3. Chung M, Reitberg DP, Gaffney M, Singleton W (1987) Clinical pharmacokinetics of nifedipine gastrointestinal therapeutic system. Am J Med 83 [Suppl 613]: 10–14

    Google Scholar 

  4. Cummings DM, Amadio P, Nelson L, Fitzgerald JM (1991) The role of calcium channel blockers in the treatment of essential hypertension. Arch Intern Med 151:250–259

    Google Scholar 

  5. Devane JG, Mulligan S, Kavanagh M; Davis SS, Sparrow RA, Wilding IR (1992) New developments in sustained-release antihypertensive therapy: formulation and pharmacokinetic considerations. Am J Cardiol 69:23E-27E

    Google Scholar 

  6. Floras JS, Jones JV, Johnson JA, Books DE, Hassan MO, Sleight P (1978) Arousal and the circadian rhythm of blood pressure. Clin Sci Mol Med 55 [Suppl]: 395S-397S

    Google Scholar 

  7. Frishman WH, Stroh JA, Grermberg S, Suarez T, Karp A, Peled H (1988) Calcium channel blockers in systemic hypertension. Med Clin North Am 72:449–499

    Google Scholar 

  8. Frishman WH, Garofalo JL, Rothschild A, Rothschild M, Greenberg SM, Soberman J (1989) The nifedipine gastrointestinal therapeutic system in the treatment of hypertension. Am J Cardiol 64:65F-69F

    Google Scholar 

  9. Gavras I, Mulinari R, Gavras H, Higgins JT, Reeves RL, Zawada ET, Crook J, Halperin AK, Garrett B (1987) Antihypertensive effectiveness of the nifedipine gastrointestinal therapeutic system. Am J Med 83 [Suppl 6B]: 20–23

    Google Scholar 

  10. Graettinger WF, Lipson JL, Cheung DJ (1988) Validation of oscillometric, auscultatory and R-wave gated auscultatory automated portable blood pressure measurements by intraarterial line and sphygmomanometer. Am Heart J 116:1155–1160

    Google Scholar 

  11. Kaplan NM (1989) Calcium entry blockers in the treatment of hypertension. J Am Med Ass 262:817–823

    Google Scholar 

  12. Krakoff LR, Bravo EL, Tuck ML, Friedman CP and the MATH Study Group (1990) Nifedipine gastrointestinal therapeutic system in the treatment of hypertension. Am J Hypertens 3:318S-325S

    Google Scholar 

  13. Kruse W, Weber E (1990) Dynamics of drug regimen compliance- its assessment by microprocessor-based monitoring. Eur J Clin Pharmacol 38:561–565

    Google Scholar 

  14. Lüscher TF, Vetter H, Siegenthaler W, Vetter W (1985) Compliance in hypertension: facts and concepts. J Hypertens 3 [Suppl 1]: S3-S9

    Google Scholar 

  15. Marler JR, Price TR, Clark GL, Muller JE, Robertson T, Mohr JP, Hier DB, Wolf PA, Caplan LR, Foulkes MA (1989) Morning increase in onset of ischemic stroke. Stroke 20:473–476

    Google Scholar 

  16. Mengden T, Binswanger B, Spühler T, Weisser B, Vetter W (1993) The use of self-measured blood pressure determinations in assessing dynamics of drug compliance in a study with amlodipine once a day, morning versus evening. J Hypertens 11:1403–1411

    Google Scholar 

  17. Myers A, Dewar HA (1975) Circumstances attending 100 sudden deaths from coronary artery disease with coroner's necropsies. Br Heart J 37: 1133–1143

    Google Scholar 

  18. Muller JE, Ludmer PL, Willich SN, Tofler GH, Aylmer G, Klangos I, Stone PH (1987) Circadian variation in the frequency of sudden cardiac death. Circulation 75: 131–138

    Google Scholar 

  19. Muller JE, Tofler GH, Stone PH (1989) Circadian variation and triggers of onset of acute cardiovascular diseases. Circulation 79: 733–743

    Google Scholar 

  20. Neutel JM, Schnaper H, Cheung DG, Graettinger WF, Weber MA (1990) Antihypertensive effects of β-blockers administered once daily: 24-h measurements. Am Heart J 120: 166–171

    Google Scholar 

  21. O'Brien E, Sheridan J, Browne T, Conroy R, O'Malley K (1989) Validation of the Spacelabs 90202 non-invasive ambulatory blood pressure recorder. J Hypertension 7 [Suppl 6]: S388-S389

    Google Scholar 

  22. Palatini P, Racioppa A, Raule G, Zaninotto M, Penzo M, Pessina AC (1992) Effect of timing of administration on the plasma ACE inhibitory activity and the antihypertensive effect of quinapril. Clin Pharmacol Ther 52: 378–383

    Google Scholar 

  23. Rudd P, Marshall G, Taylor CB, Agras WS (1981) Medication monitor/dispenser for pharmacological and compliance research (abstract). Clin Pharmacol Ther 29: 278

    Google Scholar 

  24. Verdecchia P, Schillaci G, Guerrieri M., Gatteschi C, Benemio G, Boldrini F, Porcellati C (1990) Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 81: 528–536

    Google Scholar 

  25. Weber MA, Cheung DG, Graettinger WF, Lipson JL (1988) Characterization of antihypertensive therapy by whole-day blood pressure monitoring. J Am Med Assoc 159: 3281–3285

    Google Scholar 

  26. Webster J, Robb OJ, Jeffers TA, Scott AK, Petrie JC, Towler HM (1987) Once daily amlodipine in the treatment of mild to moderate hypertension. Br J Clin Pharmacol 24: 713–719

    Google Scholar 

  27. Weinberger M (1992) Calcium antagonists for the treatment of systemic hypertension. Am J Cardiol 69: 13E-16E

    Google Scholar 

  28. Weisser B, Mengden T, Vetter W (1990) Ambulatory twenty-four-hour blood pressure measurements in pharmacological studies. J Hypertens 8 [Suppl 6]: S87-S92

    Google Scholar 

  29. White BW (1989) Methods of blood pressure determination to assess antihypertensive agents: are casual measurements enough? Clin Pharmacol Ther 45: 581–586

    Google Scholar 

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Greminger, P., Suter, P.M., Holm, D. et al. Morning versus evening administration of nifedipine gastrointestinal therapeutic system in the management of essential hypertension. Clin Investig 72, 864–869 (1994). https://doi.org/10.1007/BF00190742

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  • DOI: https://doi.org/10.1007/BF00190742

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