Results of a 14-Week, Multicenter, Prospective, Randomized, Open-Label, Noninferiority Clinical Trial Comparing the Antihypertensive Effect and Edema Incidence of Lacidipine and Amlodipine in Older Korean Patients with Mild-to-Moderate Hypertension

Abstract

Background: It has been shown that administration of lacidipine markedly reduces systolic blood pressure in elderly patients with hypertension without increasing the incidence of cardiovascular events and total mortality. But in Korea, there were no available data about the effectiveness and safety of lacidipine.

Objectives: The goal of our study was to compare the effect of lacidipine and amlodipine besylate on sitting systolic blood pressure (SBP) and edema regression time as primary parameters, and sitting diastolic blood pressure (DBP) and tolerability as a secondary parameter in patients with hypertension.

Method: This was a prospective, randomized, open-label, noninferiority study in which patients received 14 weeks of treatment with either lacidipine or amlodipine besylate. Patients aged 55 to 80 years having uncomplicated, mild-to-moderate essential hypertension (SBP 140 to <180 mm Hg or DBP ≥90 mm Hg) and receiving no antihypertensive medications during the 2 weeks before randomization were randomly assigned to receive lacidipine or amlodipine. The incidence of adverse events was also assessed.

Results: In total, 315 patients (154 men, mean age 67.6 years) were included in the intent-to-treat analysis and randomly assigned to receive lacidipine (n = 162) or amlodipine besylate (n = 153); 286 patients were included in the per-protocol analysis (n = 150 for lacidipine, n = 136 for amlodipine) (12 in the lacidipine group and 17 in the amlodipine group were excluded from the per-protocol analysis due to consent withdrawal or protocol violation). There were no differences in demographic profiles between the 2 groups. Mean (SD) SBP changes at 14 weeks were -18.9 (12.7) mm Hg in the lacidipine group and -20.6 (12.4) mm Hg in the amlodipine group (P >0.05). Because the 1-sided 95% CI for the difference in mean SBP changes between groups (-4.18 to 0.72) was within the pre-specified lower limit (-5 mm Hg), lacidipine was considered noninferior to amlodipine. There were no differences in mean edema regression time and in mean DBP changes. These results were consistent in the isolated systolic hypertension subgroup analysis. The overall incidence of clinical adverse events was comparable between the 2 groups (ie, 7.4% in the lacidipine group and 11.1% in the amlodipine group [P >0.05]). The most common adverse events were headache and facial flushing (5 out of 162 patients [3.1%] in the lacidipine group and 11 out of 153 patients [7.2%] in the amlodipine group].

Conclusions: Fourteen weeks of lacidipine treatment significantly reduced blood pressure in older Korean patients with mild-to-moderate hypertension. The efficacy of lacidipine was not inferior to that of amlodipine besylate and tolerability was comparable between the 2 treatment groups. ClinicalTrials.gov identifier: NCT00460915.

Keywords: amlodipine; blood pressure; hypertension; lacidipine.

Figure 1

Flow diagram of study patients. AE, adverse event.

Figure 2

Sitting (A) systolic blood pressure (SiSB) and (B) diastolic blood pressure (SiDBP) changes during 14-week treatment with lacidipine or amlodipine in older Korean patients with mild-to-moderate hypertension (per-protocol population). ^*P<0.001 versus baseline. No significant differences were found between the 2 groups.

Figure 3

Sitting (A) systolic blood pressure (SiSBP) and (B) diastolic blood pressure (SiDBP) changes during 14-week treatment with lacidipine or amlodipine in older Korean patients with mild-to-moderate hypertension (intent-to-treatment population). ^*P < 0.001 versus baseline. No significant differences were found between the 2 groups.

Figure 4

Comparison of edema regression time between lacidipine and amlodipine groups at baseline and 14 weeks after treatment. No significant between-group differences were found.

Figure 5

Subgroup analysis of sitting (A) systolic blood pressure (SiSBP) and (B) diastolic blood pressure (SiDBP) changes during 14-week treatment with lacidipine or amlodipine in older Korean patients with isolated systolic hypertension (per-protocol population). ^*P < 0.001 versus baseline. No significant differences were found between two groups.