Antihypertensive And Cerebroprotective Effects Of Felodipin Vs. Verapamil In Patients With Arterial Hypertension

Introduction: Leukoaraiosis is known as an independent prognostic factor for stroke, myocardial infarction, cognitive impairment or dementia. However, the possibilities of antihypertensive therapy in regression of leukoaraiosis are not well studied. Objective: To compare of antihypertensive and cerebroprotective effects of 6 months-long treatment with felodipin (F) (FELODIP®, «TEVA») and verapamil (V) (ISOPTIN SR®, «Abbott») in hypertensive patients. Methods: We studied 53 hypertensive pts (24 men, aged 30 to 67 y.o). Among them, 29 pts (16 men) were receiving F 5–10 mg once-daily, and 24 pts (8 men) were taken V 240 -480 mg per day (once- or twice-daily) through 6 months. Following parameters were estimated: 24-hours blood pressure (BP) monitoring and brain MRI. Results: In all patients there was a significant fall of blood pressure (p < 0.05) that was did not differ with respect to the antihypertensive agent used. F decreased systolic/diastolic BP level at 10.4/10.4% and V reduced BP at 10.0/8.5%. However, there was a difference in the effect of therapy on nocturnal BP dipping: in F-group there was normalization index nocturnal systolic BP (SBP) fall in non-dippers (from 4.4 ± 1.9% to 10.0 ± 3.9%, p < 0.05), over-dippers (from 23.0 ± 2.8% to 15.0 ± 7.7%, p < 0.05) and not change that in dippers (from 12.5 ± 3.2% to 11.0 ± 4.0%). In V-group there was decrease of index nocturnal SBP fall in dippers (from 13.4 ± 2,8% to 8.0 ± 4.0% p < 0.05), not change that in non-dippers (from 5.0 ± 1.6% to 7.2 ± 4.4%, p > 0.05) and non significant decrease that in over-dippers (from 22.5 ± 2.1% to 16.0 ± 1.4%, p > 0.05). In all patients there was significant decrease of depth of leukoaraiosis (from 2.5 ± 0.9 to 2.0 ± 0.8 mm, p < 0.05 for F-group, and from 2.2 ± 0.7 to 1.5 ± 0.9 mm, p < 0.05 for V-group). At the same time, regression of leukoaraiosis was achieved more frequently of pts in F-group, than of pts in V-group (50% vs. n = 14%, p < 0.05). Conclusion: Antihypertensive therapy by felodipin in hypertensive patients exerted a more favorable influence on the circadian rhythm of blood pressure and was more effective for the regression of leukoaraiosis than treatment by verapamil.