Antihypertensive Effectiveness of Nifedipine Gastrointestinal Therapeutic System in the Elderly

Abstract

The Modern Approach to the Treatment of Hypertension (MATH) trial was conducted to determine the therapeutic safety and efficacy of the once-a-day nifedipine gastrointestinal therapeutic system (GITS) formulation in a large and diverse cohort of patients with mild-to-moderate hypertension. One of the goals of the MATH study was to evaluate the clinical utility of nifedipine GITS in elderly hypertensives. This analysis compares the safety and efficacy of nifedipine GITS in elderly patients (≥ 65 years of age) and nonelderly patients (adults <65 years of age). A total of 222 elderly and 933 nonelderly patients from 127 centers were evaluated. Following a 2 week placebo washout phase, patients were titrated over 1 to 6 weeks on nifedipine GITS 30 to 180 mg/day, increasing in 30 mg increments to achieve goal blood pressure, defined as sitting diastolic blood pressure of <90 mm Hg and a 10 mm Hg decrease from baseline. Therapy was maintained at the optimal dose for an additional 12 weeks. Hemodynamic and laboratory parameters were assessed at baseline and at the final treatment visit. Baseline parameters were comparable between patient groups except for systolic blood pressure, which was significantly greater in the elderly compared with nonelderly patients (164 ± 18 v 150 ± 14 mm Hg, respectively, P < .0001). After 12 weeks of therapy with nifedipine GITS, sitting and standing systolic and diastolic blood pressure was significantly decreased from baseline for both elderly and nonelderly patients. While diastolic blood pressure was decreased to a similar degree in both groups, change in systolic blood pressure from baseline was greater in the elderly patients. A small statistically, but not clinically, significant increase in heart rate was seen in nonelderly but not elderly patients; no orthostatic hypotension occurred. Goal blood pressure reduction was achieved in 85% of elderly patients and in 74% of nonelderly patients at the end of the titration phase. Nifedipine GITS was well tolerated, with a low incidence of side effects that was comparable between age groups. It may be concluded that nifedipine GITS is well tolerated as once-daily monotherapy in hypertensive adults, regardless of age, and is particularly well suited for use in the elderly hypertensive population. Am J Hypertens 1990;3:326S-332S