| Abstract
| - Use of thiazide diuretics and β-blockers in the treatment of hypertension may result in metabolic derangements and/or disturbances in the parameters of renal function, which offset the benefits of blood pressure reduction by adversely affecting other cardiovascular risk factors, particularly in special patient groups such as the elderly or those with concomitant diseases. Newer agents including calcium channel blockers, which exert potent antihypertensive effects without adversely affecting metabolic parameters unfavorably, are used with increasing frequency in hypertensive patients, but their clinical utility has been limited by the need for multiple daily dosing with attendant fluctuations in plasma levels thought to be associated with nuisance side effects and possible gaps in therapeutic protection. The Modern Approach to the Treatment of Hypertension (MATH) trial was conducted to determine the efficacy and safety of the new once-daily nifedipine gastrointestinal therapeutic system (GITS) formulation in a large cohort of mild-to-moderate hypertensive patients overall, and to identify specific effects of therapy in the presence of complicating factors such as diabetes and obesity. A total of 1155 patients from 127 centers were treated with nifedipine GITS in the MATH trial, including 157 diabetic (fasting plasma glucose >120 mg/dL or on hypoglycemic therapy) and 747 nondiabetic patients. There were 458 obese patients (body mass index [BMI] > 30), 489 overweight patients (BMI ≥ 2 5 ≤30), and 206 patients of normal weight (BMI < 25). Following baseline enrollment and a placebo washout period, patients were titrated over 1 to 6 weeks in 30 mg/day increments to the dose of nifedipine GITS between 30 and 180 mg/day at which goal blood pressure reduction was achieved (a 10 mm Hg decrease in sitting diastolic blood pressure and sitting diastolic blood pressure > 90 mm Hg). Therapy was maintained at the optimal dose for 12 weeks with allowance for 1 dose level adjustment. Hemodynamic and laboratory parameters including measurements of serum electrolytes, lipids, and renal and metabolic variables were assessed at baseline and at the end of treatment. Subgroup analyses of the MATH data base reveal that nifedipine GITS effectively reduced blood pressure in nondiabetic and diabetic patients and in obese, overweight, and normal weight patients. Moreover, nifedipine GITS did not adversely affect plasma glucose levels, lipid levels, serum electrolytes, or renal function in the subgroups of patients tested. The MATH trial results indicate that nifedipine GITS is a particularly useful agent for the treatment of essential hypertension in a wide range of patients, including those at increased risk for cardiovascular disease due to concomitant metabolic conditions such as diabetes or obesity. Am J Hypertens 1990;3:333S-341S
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