DIFFERENT EFFECTS OF MANIDIPINE AND LERCANIDIPINE ON BLOOD PRESSURE, PERIPHERAL CIRCULATION AND ANKLE OEDEMA IN HYPERTENSIVE PATIENTS

Abstract

P2.330; Citation: Journal of Hypertension Volume 22, Supplement 2, June 2004, page S244 DIFFERENT EFFECTS OF MANIDIPINE AND LERCANIDIPINE ON BLOOD PRESSURE, PERIPHERAL CIRCULATION AND ANKLE OEDEMA IN HYPERTENSIVE PATIENTS V. Tikhonoff, A. Mazza, E. Casiglia, A.C. Pessina Department of Clinical and Experimental Medicine, University of Padua, Via Giustiniani 2, 35128 Padua, Italy Objectives: To evaluate the oedemigenous effect and the anti-hypertensive efficacy of two newgeneration dihydropyridine calcium channel blockers, manidipine and lercanidipine. Design and Methods: The study was a randomized, controlled, parallel group trial. After a 2-week placebo run-in, 53 mild-to-moderate hypertensive patients aged 18-75 years were treated for 12 weeks with either manidipine (10 mg/day) or lercanidipine (10 mg/day) by oral route in the morning. 24-hour blood pressure (BP) and heart rate were recorded with a TM-2430 device (Takeda, Tokyo, Japan). Leg arterial flow (ml⋅min−1⋅dl−1) was measured with strain-gauge plethysmography (Angioflow, Microlab, Padova, Italy) both at rest and after ischemia, at baseline as well as at the end of treatment. Peripheral resistances (mmHg⋅min⋅dl⋅ml−1) were calculated as the mean BP/flow ratio; minimal arterial resistance calculated from peak flow was taken as an indirect measure of arterial wall thickness. Ankle volume was assessed with water-displacement plethysmography, and ankle oedema calculated for each drug as difference between baseline and post-treatment volume. Results: In comparison to baseline, daytime BP decreased from 147±15/85±7 to 139±16/80±10 mmHg with manidipine (systolic and diastolic: p<0.001) and from 147±12/85±9 to 141±12/79±6 mmHg with lercanidipine (systolic and diastolic: p<0.001). Normalization of BP (<140 and <90 mmHg) was observed in 35% of cases after manidipine and in 18% after lercanidipine (p<0.005 between treatments). HR remained unchanged with both drugs. Rest and post-ischaemic vascular peripheral resistance significantly decreased after manidipine (−30%, p<0.005) but not after lercanidipine. Ankle volume significantly increased (+6.6%) after lercanidipine, whereas no significant increase was observed after manidipine. Conclusions: Both manidipine and lercanidipine were effective in reducing BP; however, the rate of normalization was double with manidipine with respect to lercanidipine. Compared to lercanidipine, manidipine was more potent as a vasodilator and, despite the short-term treatment, reduced arteriolar wall thickness as shown by the reduced maximal arterial resistance. Finally, vasodilatory edema was less pronounced with manidipine than with lercanidipine treatment.