Reduction of white coat effect by cilnidipine in essential hypertension

Stress elevates blood pressure (BP) by increased sympathetic nerve activity . Cilnidipine, a novel dihydropyridine calcium antagonist that has inhibito ry actions on N-type as well as L-type voltage-dependent calcium channels, has been reported to attenuate the cold stress-induced increase in plasma n orepinephrine and BP in rats. Because white coat effect is associated with an enhanced pressor response to mental stress, we postulated that cilnidipi ne would attenuate white coat effect in patients with essential hypertensio n. Sixty-one consecutive outpatients (50 men, 11 women) with essential hyperte nsion were studied prospectively. Twenty-nine patients were treated with ei ther cilnidipine (n = 15) or nifedipine, a representative L-type voltage-de pendent calcium antagonist (n = 14). Gender, age, body mass index, duration of hypertension, target organ damage of hypertension, and BP and heart rat e (HR) were not significantly different between cilnidipine and nifedipine groups, and both systolic (SBP) and diastolic BP (DBP) were significantly d ecreased after treatment in both groups. White coat effects on systolic and DBP and HR were not significantly different between, groups before antihyp ertensive treatment. Cilnidipine, but not nifedipine, significantly reduced white coat effects on SBP and HR. Furthermore, white coat effects on systo lic BP and HR were significantly lower after treatment in the cilnidipine g roup compared with the nifedipine group. These data suggest that cilnidipin e may reduce white coat effect in hypertensive patients by N-type calcium c hannel antagonism. Am J Hypertens 2001;14:1053-1057 (C) 2001 American Journ al of Hypertension, Ltd.