Differential effects of felodipine and nifedipine on 24-h blood pressure and left ventricular mass

1,4-Dihydropyridine calcium antagonists, which have a rapid onset and short duration of action, tend to increase sympathetic activity, which may limit the regression of left ventricular hypertrophy when used for the treatment of hypertension. This study compares the effects of the shorter-acting formulation of nifedipine (PA) with longer-acting felodipine (ER) on 24-h blood pressure and left ventricular mass in patients with uncomplicated essential hypertension. Subjects were randomly allocated to receive nifedipine (n = 52) or felodipine (n = 56) over 8 weeks at increasing doses until the sitting office diastolic blood pressure (DBP) was < 90 mm Hg. An ambulatory blood pressure (ABP) recording and echocardiogram were performed at baseline and upon completion of the study. At the end of the dosing interval, felodipine lowered office DBP (mm Hg) by -18 ± 12/14 ± 1 compared to -14 ± 2/11 ± 1 for nifedipine (P< .05). Mean 24-h ABP was reduced (P< .001) by felodipine (−15 ± 1/-10 ± 1 mm Hg) and nifedipine (−15 ± 1/-9 ± 2 mm Hg). However, nifedipine caused an apparent biphasic response with felodipine reducing (P< .05) blood pressure more in the early afternoon compared to nifedipine. Left ventricular mass index was significantly reduced (P< .01) by felodipine (-6 ± 1 g/m2), but not by nifedipine. Once-daily administration of felodipine achieves a more consistent control of blood pressure compared to twice-daily nifedipine and may be associated with a greater reduction in left ventricular mass.