Blood pressure-lowering effects of nifedipine/candesartan combinations in high-risk individuals: Subgroup analysis of the DISTINCT randomised trial

G. Mancia, G. Cha, B. Gil-Extremera, P. Harvey, A. J. Lewin, G. Villa, S. E. Kjeldsen, J. Agaiby, N. Aggarwal, P. Ainsworth, R. Akhras, V. Amaluan, A. Ballarin, L. Bardauskiene, F. C. Berra, M. Blagden, B. Bodalia, C. Borghi, C. Bundy, L. BurgessR. Buynak, A. Cafferata, T. Cahill, L. Capiau, V. Capuano, R. Casanova, J. Cecil, G. Cha, J. Chapman, M. Chilvers, S. Christensen, Y. H. Cho, W. B. Chung, F. Cipollone, A. Coca, H. Colombo, E. M. Contreras, D. Crowley, B. Cusco-Prieto, F. Decarlini, J. H. Doh, P. Dzongowski, G. Dzyak, A. Ellery, B. G. Extremera, E. Farias, C. Farrington, J. Fidelholtz, L. Fouche, A. Gabito, M. Gainza, M. Gani, R. Gaunt, E. Gelersztein, M. Giuliano, A. Glazunov, N. Glorioso, B. Goloschekin, M. Gumbley, A. Gupta, L. Guzman, J. W. Ha, R. Hart, P. Harvey, D. Haworth, S. Henein, D. Henry, S. H. Her, F. Heyvaert, G. Hollanders, M. Hominal, B. K. Hong, T. J. Hong, K. K. Hwang, A. Jacovides, J. Jacqmein, H. K. Jeon, N. Jones, S. Kanani, H. Kang, O. Karpenko, D. Kenton, N. Kimzey, S. E. Kjeldsen, V. Kovalenko, M. Kushnir, B. Lasko, K. J. Lee, N. Lee, A. Lewin, M. Litvak, D. Luksiene, C. Majul, E. Mannarino, O. Manuale, A. Marcadis, D. Miller, R. Mills, K. Misik, J. Mortelmans, M. O'Mahony, W. O'Mahony, C. Park, R. Pedrinelli, Z. Petrulioniene, F. Pettyjohn, D. Piskorz, G. Poss, K. Pudi, W. B. Pyun, G. Raad, G. Raila, M. F. Ramirez Espinosa, P. Ramlachan, M. Rhee, L. Rudenko, T. S. Ruiz, J. Ryan, G. Schacter, J. H. Shin, D. Short, D. Sica, Y. Sirenko, R. Slapikas, R. Somani, M. Stanislavchuk, R. Stewart, Y. Svishchenko, O. Sychov, I. Teitelbaum, V. Tseluyko, D. J. Van Rensburg, J. V. Vaquer Perez, L. M. Via, M. Vico, G. Villa, V. Vizir, D. Vogel, H. Wellmann, B. S. Yoo

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The DISTINCT study (reDefining Intervention with Studies Testing Innovative Nifedipine GITS - Candesartan Therapy) investigated the efficacy and safety of nifedipine GITS/candesartan cilexetil combinations vs respective monotherapies and placebo in patients with hypertension. This descriptive sub-analysis examined blood pressure (BP)-lowering effects in high-risk participants, including those with renal impairment (estimated glomerular filtration rate<90 ml min-1, n=422), type 2 diabetes mellitus (n=202), hypercholesterolaemia (n=206) and cardiovascular (CV) risk factors (n=971), as well as the impact of gender, age and body mass index (BMI). Participants with grade I/II hypertension were randomised to treatment with nifedipine GITS (N) 20, 30, 60 mg and/or candesartan cilexetil (C) 4, 8, 16, 32 mg or placebo for 8 weeks. Mean systolic BP and diastolic BP reductions after treatment in high-risk participants were greater, overall, with N/C combinations vs respective monotherapies or placebo, with indicators of a dose-response effect. Highest rates of BP control (ESH/ESC 2013 guideline criteria) were also achieved with highest doses of N/C combinations in each high-risk subgroup. The benefits of combination therapy vs monotherapy were additionally observed in patient subgroups categorised by gender, age or BMI. All high-risk participants reported fewer vasodilatory adverse events in the pooled N/C combination therapy than the N monotherapy group. In conclusion, consistent with the DISTINCT main study outcomes, high-risk participants showed greater reductions in BP and higher control rates with N/C combinations compared with respective monotherapies and lesser vasodilatory side-effects compared with N monotherapy.

Original languageEnglish
Pages (from-to)178-188
Number of pages11
JournalJournal of Human Hypertension
Issue number3
StatePublished - 1 Mar 2017

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