Abstract
The relationship between the age and clinical efficacy of calcium entry blocker, nicardipine, was investigated in essential hypertension by using a double blind group comparison method. In Monotherapy study, 82 patients were divided into three groups; 16 younger patients of less than 49 years (mean age of 43.2 years), 31 of middle aged patients of fifties (mean age of 54.0 years), and 35 elderly patients of 60 years or more (mean age of 66.1 years). In combination therapy with diuretics, 63 patients were enrolled in the study, consisting of 38 younger patients of 59 years or less (mean age of 50.3 years), and 25 elderly patients of 60 years or more (mean age of 66.4 years). Nicardipine was used 20mg three times daily for 12 weeks in both studies. The positive antihypertensive effect was defined as blood pressure fall of 20/10mmHg in systolic/diastolic pressure or a decrease of 13mmHg or more in mean pressure. In nicardipine monotherapy, this effect was observed in 43.8% of younger patients, in 63.3% in middle aged patients, and in 66.7% in the elderly patients, showing no significant difference in each age group. In combination therapy with diuretics, the hypotensive effect was demonstrated in 71.1% in the younger patients and in 68.0% in the elderly patients. There was no significant difference between the two age groups. The average decrease in blood pressure was 19-24/10-13mmHg in the monotherapy, and 20-25/14-15mmHg in the combined therapy, and was not different in each age gorup. The fall in blood pressure was not correlated with the age, but with the pretreatment blood pressure. Heart rate changed little in both monotherapy and combined therapy. The incidence of side effect was 0% in the younger patients, in 25.8% in the middle aged patients and in 14.3% in the elderly patients in the monotherapy. The incidence of side effect was higher in the middle aged patients than the younger patients, the side effect was observed in 13.2% in the younger patients and in 12.0% in the elderly patients, showing no significant difference. The laboratory data revealed no metabolic effect to raise risk factor in each age group. The comprehensive efficacy was judged by the hypotensive effect, side effect and the clinical and laboratory findings, and the rate of usefulness (useful or above) was 56.3% in the younger patients, 58.1% in the middle age patients, and 65.7% in the elderly patients in the monotherapy, while the rate in combined therapy was 65.8% in the younger patients and 60.0% in the elderly patients. There was no significant difference in each age group in either therapy. The calcium entry blocker, nicardipine, is considered to be equally useful for the aged and younger patients in the treatment of essential hypertension.
