(Hypertension. 2000;36:622.)
© 2000 American Heart Association, Inc.
Scientific Contributions |
Lacidipine and Blood Pressure Variability in Diabetic Hypertensive Patients
From Clinica Medica (F.P., G.R., G. Mauri, G. Mancia), University of Milano-Bicocca and Ospedale S. Gerardo, Monza; Istituto Scientifico Ospedale S. Luca (A.F., G.P., L.U.), IRCCS Istituto Auxologico Italiano, Milano; and Laboratorio di Ricerche Cardiovascolai (P.C., M.D.R.), Centro di Bioingegneria, IRCCS Fondazione Don C. Gnocchi, Milano, Italy.
Correspondence to Giuseppe Mancia, MD, Clinica Medica, Università di Milano-Bicocca, Ospedale S. Gerardo, Via Donizetti 106, 20052 Monza, Italy. E-mail mancia.g{at}mailserver.unimi.it
Abstract—The aim of our study was
to assess the effects of lacidipine, a long-acting calcium
antagonist, on 24-hour average blood pressure, blood
pressure variability, and baroreflex sensitivity. In 10 mildly to
moderately hypertensive patients with type II diabetes mellitus (aged
18 to 65 years), 24-hour ambulatory blood pressure was continuously
monitored noninvasively (Portapres device) after a 3-week pretreatment
with placebo and a subsequent 4-week once daily lacidipine (4 mg) or
placebo treatment (double-blind crossover design). Systolic
blood pressure, diastolic blood pressure, and heart rate
means were computed each hour for 24 hours (day and night) at the end
of each treatment period. Similar assessments were also made for blood
pressure and heart rate variability (standard deviation and variation
coefficient) and for 24-hour baroreflex sensitivity, which was
quantified (1) in the time domain by the slope of the spontaneous
sequences characterized by progressive increases or reductions of
systolic blood pressure and RR interval and (2) in the
frequency domain by the squared ratio of RR interval and
systolic blood pressure spectral power 
0.1 and 0.3 Hz over
the 24 hours. Compared with placebo, lacidipine reduced the 24-hour,
daytime, and nighttime systolic and diastolic blood
pressure (P<0.05) with no significant change in heart
rate. It also reduced 24-hour, daytime, and nighttime standard
deviation (-19.6%, -14.4%, and -24.0%, respectively;
P<0.05) and their variation coefficient. The 24-hour
average slope of all sequences (7.7±1.7 ms/mm Hg) seen during placebo
was significantly increased by lacidipine (8.7±1.8 ms/mm Hg,
P<0.01), with a significant increase being obtained
also for the 24-hour average 
coefficient at 0.1 Hz (from 5.7±1.5
to 6.4±1.3 ms/mm Hg, P<0.01). Thus, in diabetic
hypertensive patients, lacidipine reduced not only 24-hour blood
pressure means but also blood pressure variability. This reduction was
accompanied by an improvement of baroreflex sensitivity. Computer
analysis of beat-to-beat 24-hour noninvasive blood pressure
monitoring may offer valuable information about the effects of
antihypertensive drugs on hemodynamic and autonomic
parameters in daily life.
Key Words: blood pressure monitoring, ambulatory • calcium antagonists • hypertension, essential • diabetes mellitus • baroreflex
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