Efficacy and Safety of S-Amlodipine 2.5 and 5 mg/d in Hypertensive Patients Who Were Treatment-Naive or Previously Received Antihypertensive Monotherapy

Selçuk Şen, Meral Demir, Zerrin Yiğit, Ali Yağız Üresin, Selçuk Şen, Meral Demir, Zerrin Yiğit, Ali Yağız Üresin

Abstract

The aim of the present study was to evaluate the efficacy and safety of S-amlodipine 2.5 and 5 mg/d in patients with hypertension who were treatment-naive or previously received antihypertensive monotherapy. During the 8-week treatment period, all patients received S-amlodipine 2.5 mg/d for the first 4 weeks, followed by S-amlodipine 5 mg/d for the second 4 weeks. For efficacy assessments, ambulatory and office blood pressure (BP) measurements were performed during the baseline, fourth-week, and eighth-week visits. For safety assessments, all adverse events and abnormal laboratory findings were recorded. This study is registered with ClinicalTrials.gov (NCT03038451). Of 43 patients evaluated at the screening visit, 33 were enrolled. In the treatment-naive arm, significant reductions in both office and ambulatory systolic BP (SBP) and diastolic BP (DBP) were observed with S-amlodipine 2.5 mg/d and additional significant reductions were achieved with dose titration (S-amlodipine 5 mg/d). At the end of the study, the rate of the treatment-naive patients with BP under control (SBP/DBP <140/90 mm Hg) was 53% with S-amlodipine 2.5 mg and increased to 78% with S-amlodipine 5 mg. For the noninferiority evaluation, S-amlodipine 2.5 and 5 mg/d treatments were generally noninferior to both office and ambulatory BP levels achieved with the medications that the patients received before participating in the study. Five nonserious adverse events likely to be associated with the study drug were observed. No serious adverse event was encountered. Consequently, S-amlodipine can be suggested as an effective and safe treatment option for patients with hypertension.

Keywords: S-amlodipine; efficacy; hypertension; safety.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Study flow chart.
Figure 2.
Figure 2.
Changes in systolic blood pressures (SBP) after 4 weeks of treatment with S-amlodipine 2.5 mg/d.
Figure 3.
Figure 3.
Changes in systolic blood pressures (SBP) after 4 weeks of treatment with S-amlodipine 5 mg/d.
Figure 4.
Figure 4.
Changes in diastolic blood pressures (DBP) after 4 weeks of treatment with S-amlodipine 2.5 mg/d.
Figure 5.
Figure 5.
Changes in diastolic blood pressures (DBP) after 4 weeks of treatment with S-amlodipine 5 mg/d.

References

    1. CDC. High blood pressure facts. . Accessed October 5, 2017.
    1. Mills KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134(6):441–450.
    1. World Health Organization. A global brief on hypertension. World Health Day 2013. . Updated April, 2013. Accessed October 5, 2017.
    1. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387(10022):957–967.
    1. Mancia G, Kjeldsen SE, Zappe DH, et al. Cardiovascular outcomes at different on-treatment blood pressures in the hypertensive patients of the VALUE trial. Eur Heart J. 2016;37(12):955–964.
    1. Grossman E. Blood pressure: the lower, the better: the con side. Diabetes Care. 2011;349(Suppl 2):S308–S312.
    1. Moser M, Hebert PR. Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials. J Am Coll Cardiol. 1996;27(5):1214–1218.
    1. Shrout T, Rudy DW, Piascik MT. Hypertension update, JNC8 and beyond. Curr Opin Pharmacol. 2017;33:41–46.
    1. Haria M, Wagstaff AJ. Amlodipine. A reappraisal of its pharmacological properties and therapeutic use in cardiovascular disease. Drugs. 1995;50(3):560–586.
    1. Thacker HP. S-amlodipine–the 2007 clinical review. J Indian Med Assoc. 2007;105(4):180–182, 184, 186 passim.
    1. Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension. 2005;45(1):142–161.
    1. Scholz H. Pharmacological aspects of calcium channel blockers. Cardiovasc Drugs Ther. 1997;10(suppl 3):869–872.
    1. Short Product Information of S-NOR 2.5 mg tablet. . Updated February 12, 2012. Accessed October 5, 2017.
    1. Guo J, Gong Y, Li Y. The effectiveness of s-amlodipine on vascular function. Journal of Hypertension. 2012;30: Abstracts e251.
    1. Iskenderov BG, Saushkina SV. Organoprotective and metabolic effects of S-amlodipine in patients with arterial hypertension. Kardiologiia. 2013;53(10):24–29.
    1. Park JY, Kim KA, Park PW, et al. Pharmacokinetic and pharmacodynamic characteristics of a new S-amlodipine formulation in healthy Korean male subjects: a randomized, open-label, two-period, comparative, crossover study. Clin Ther. 2006;28(11):1837–1847.
    1. Kim BH, Kim JR, Kim MG, et al. Pharmacodynamic (hemodynamic) and pharmacokinetic comparisons of S-amlodipine gentisate and racemate amlodipine besylate in healthy Korean male volunteers: two double-blind, randomized, two-period, two-treatment, two-sequence, double-dummy, single-dose crossover studies. Clin Ther. 2010;32(1):193–205.
    1. Kim SA, Park S, Chung N, et al. Efficacy and safety profiles of a new S(-)-amlodipine nicotinate formulation versus racemic amlodipine besylate in adult Korean patients with mild to moderate hypertension: an 8-week, multicenter, randomized, double-blind, double-dummy, parallel-group, phase III, noninferiority clinical trial. Clin Ther. 2008;30(5):845–857.
    1. Liu F, Qiu M, Zhai SD. Tolerability and effectiveness of (S)-amlodipine compared with racemic amlodipine in hypertension: a systematic review and meta-analysis. Curr Ther Res Clin Exp. 2010;71(1):1–29.
    1. Oh GC, Lee HY, Kang HJ, Zo JH, Choi DJ, Oh BH. Quantification of pedal edema during treatment with S(-)-amlodipine nicotinate versus amlodipine besylate in female Korean patients with mild to moderate hypertension: a 12-week, multicenter, randomized, double-blind, active-controlled, phase IV clinical trial. Clin Ther. 2012;34(9):1940–1947.
    1. Padmavathi T, Ezhil Ramya J, Meeanakshi B. A randomized, prospective study to compare the efficacy and tolerability of S-Amlodipine 2.5 mg versus racemic amlodipine 5 mg in mild to moderate hypertension. RRJPTS. 2014;2(2):26–33.
    1. Pathak L, Hiremath Kerkar PG, Manade VG. Multicentric, clinical trial of S-Amlodipine 2.5 mg versus Amlodipine 5 mg in the treatment of mild to moderate hypertension–a randomized, double-blind clinical trial. J Assoc Physicians India. 2004;52:197–202.
    1. Hu SL, Zhang Y, He J, Du L. A retrospective cost-effectiveness analysis of S-Amlodipine in China. Value Health. 2014;17(7):A758.
    1. Chen Q, Huang QF, Kang YY, et al. Efficacy and tolerability of initial high vs low doses of S-(-)-amlodipine in hypertension. J Clin Hypertens (Greenwich). 2017;19(10):973–982.
    1. Galappatthy P, Waniganayake YC, Sabeer MI, Wijethunga TJ, Galappatthy GK, Ekanayaka RA. Leg edema with (S)-amlodipine vs conventional amlodipine given in triple therapy for hypertension: a randomized double blind controlled clinical trial. BMC Cardiovasc Disord. 2016;16(1):168.

Source: PubMed

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