Combination of dihydropyridine and non-dihydropyridine calcium antagonists in patients with arterial hypertension and coronary heart disease: efficacy and safety

Abstract

Aim. To study antihypertensive and anti-ischemic effects on structural and functional heart status, and assess treatment safety for combination of dihydropyridine and non-dihydropyridine calcium antagonists (CA). Material and methods. The authors examined 31 patients with Stage II-III, level II arterial hypertension (AH) (Society of Cardiology of the Russian Federation, 2001), and coronary heart disease (CHD), effort angina, Functional Class (FC) II-III. Twenty-four-hour electrocardiography (ECG) and blood pressure (BP) monitoring, Doppler echocardiography (EchoCG) were performed. Combined therapy with amlodipine and verapamil retard lasted for 24 weeks. Results. During the treatment, in 77.4% of the patients, complete antihypertensive effect (BP<140/90 mm Hg) was observed; in 22.6%, this effect was partial (diastolic BP decrease by 10 mm Hg). Mean decrease in left ventricular myocardial mass index was 24.9±2.3 g/m2 (p<0.01). Diastolic function improved: early and late flow velocity ratio (E/A) increased by 10.3% (p<0.05); isovolumic relaxation time reduced by 13.6% (p<0.01). Maximal depth of ST segment depression decreased from 2.3±0.2 to 1.5±0.1 mm. Duration and frequency of painless myocardial ischemia decreased, too. Adverse effect rate was by 1.5-4 times lower than for monotherapy. Conclusion. Combination of dihydropyridine and non-dihydropyridine CA demonstrated its antihypertensive, anti-ischemic, and cardioprotective effects, and was well tolerated.

Keywords

• arterial hypertension
• calcium antagonists
• verapamil retard
• amlodipin