Long-acting nifedipine for hypertensive patients in the Middle East and Morocco: observations on efficacy and tolerability of monotherapy or combination therapy

Abstract

Background: The Middle Eastern and North African region of developing countries is associated with poor rates of blood pressure (BP) control and antihypertensive prescribing patterns. This post hoc analysis of data from an international observational study aimed to investigate the efficacy and tolerability of long-acting nifedipine (30 mg or 60 mg; monotherapy or in combination) in the Middle Eastern and Moroccan populations defined as having high cardiovascular risk.

Methods: This was a prospective, noninterventional, multicenter observational study. Observations from patients (aged ≥ 18 years) with treated or untreated hypertension from the Middle East (Jordan, Saudi Arabia, Kuwait, Lebanon, Qatar, United Arab Emirates, and Yemen) and Morocco are presented. Hypertension grade and cardiovascular risk were defined at baseline, and systolic/diastolic BP change was defined at post-baseline visits (≤3). Adverse events and ratings of therapy efficacy and patient/physician satisfaction were recorded.

Results: The study included 1466 patients from the Middle East and 524 from Morocco. Characteristics of the populations differed, with a more severe hypertension profile in Moroccan patients. Despite these differences, nifedipine reduced BP to a similar extent in each group, with efficacy dependent on cardiovascular risk factors such as hypertension grade and age. Few adverse drug reactions occurred and nifedipine was well-tolerated in both populations. Efficacy and satisfaction with therapy were rated highly.

Conclusion: Good rates of BP control were observed with nifedipine in patients with moderate-to-severe hypertension and high added risk. Published data in these countries suggest poor antihypertensive prescribing patterns and BP control; these data confirm this trend and suggest that suboptimal dosing may be prevalent.

Keywords: antihypertensive; blood pressure; cardiovascular risk; hypertension; safety; tolerability.

Figure 1

Study course for each population and antihypertensive dosing. Notes:^aSome doses were missing or patients were using other doses; ^bconcomitant medication included angiotensin converting enzyme inhibitors, type 1 angiotensin II-receptor antagonists, β-blocking agents, calcium channel blockers, diuretics, and other antihypertensives.

Figure 2

Mean systolic and diastolic blood pressure in each population by visit. Note: Error bars represent standard deviations.

Figure 3

Mean change in SBP and DBP (ΔmmHg) achieved from initial to final visit for each population, according to initial SBP and DBP. Notes:^aOne patient with a low starting BP(<130 mmHg) showed an increase in SBP of 63 mmHg. The reason for this is unknown. Abbreviations: BP, blood pressure; DBP, diastolic BP; SBP, systolic BP.

Figure 4

Mean systolic and diastolic blood pressure in each population at initial and last visit by type of therapy (nifedipine monotherapy or combined therapy). Note: Error bars represent standard deviations.