EFFECT OF ISRADIPINE IN BLACK PATIENTS WITH VERY SEVERE HYPERTENSION - 24-HOUR AMBULATORY BLOOD-PRESSURE MONITORING AND ECHOCARDIOGRAPHIC EVALUATION

Fifty consecutive black patients with very severe hypertension (sittin g diastolic blood pressure greater than or equal to 120 mm Hg and syst olic greater than or equal to 210 mm Hg by the conventional cuff metho d) were treated in an open-label study (without a placebo or active dr ug control group) for 3 months with a long-acting preparation of israd ipine (Dynacirc SRO), during which time serial changes in 24-h ambulat ory blood pressure monitoring (ABPM), left ventricular (LV) mass index , and LV systolic function were evaluated. Mean 24-h ABPM was reduced from 184 +/- 13/119 +/- 6 to 148 +/- 18/96 +/- 11 mm Hg at 3 months (P <.0001). The reduction in BP was sustained for 24 h after dosing. Sim ultaneous BP measurements using a conventional cuff method and Dinamap were significantly different from the ABPM pre- and posttherapy, sugg esting a marked ''white coat'' presser effect. LV mass index regressed from 143 +/- 36 to 122 +/- 32 g/m(2) at 3 months (P <.02). Heart rate and mean body weight were unchanged. Left ventricular performance was not adversely affected. Cardiac index and fractional shortening chang ed insignificantly, from 2.6 +/- 0.6 to 2.7 +/- 0.5 L/min/m(2), and fr om 28 +/- 6 to 31 +/- 7%, respectively. Adverse effects were few and t ended to disappear during the treatment period. All of the clinical la boratory parameters tested remained unchanged. We conclude that in thi s group of patients long-acting isradipine 1) showed a marked and sust ained antihypertensive action demonstrated by 24-h ABPM; and 2) was we ll tolerated and associated with LV mass regression without adverse ef fect on systolic cardiac function. Furthermore, had dose titration dec isions been based on conventional sphygmomanometry rather than 24-h AB PM, doses would have been markedly higher. One should be aware of this when uptitrating patients with severe hypertension.