Why is nifedipine (a calcium channel blocker) prescribed for elderly people with hypertension?

From the Guidelines

Nifedipine is prescribed for elderly people with hypertension because it is effective in reducing cardiovascular morbidity and mortality with fewer side effects compared to other antihypertensive medications, as shown in studies such as the 2007 guidelines for the management of arterial hypertension 1.

Key Points

• Nifedipine belongs to a class of medications called calcium channel blockers that work by relaxing blood vessels, allowing blood to flow more easily and reducing the workload on the heart.
• The typical starting dose for elderly patients is lower than for younger adults, usually 10-20 mg of the extended-release formulation once daily, which can be gradually increased if needed, as initial doses and subsequent dose titration should be more gradual because of a greater chance of undesirable effects, especially in very old and frail subjects 1.
• Common side effects include headache, flushing, swelling in the ankles or feet, and dizziness, and elderly patients should take nifedipine with caution if they have liver problems, as the medication is metabolized by the liver.
• The British Hypertension Society guidelines also support the use of calcium channel blockers, such as nifedipine, in elderly patients with isolated systolic hypertension 1.

Benefits and Considerations

• The benefits of nifedipine in elderly patients with hypertension include reducing the risk of cardiovascular events, such as stroke and heart attack, as demonstrated in studies such as the STOP-2 and ALLHAT trials 1.
• However, it is essential to consider the potential risks and side effects, such as postural hypotension, and to monitor blood pressure regularly while taking nifedipine.
• The medication should be taken consistently, usually at the same time each day, and should not be stopped abruptly without medical supervision.

Conclusion is not allowed, so the answer will be ended here.

From the FDA Drug Label

The mean trough (24 hours post-dose) blood pressure results from these studies are shown below: The trough/peak ratios estimated from 24 hour blood pressure monitoring ranged from 41%-78% for diastolic and 46%-91% for systolic blood pressure. Nifedipine extended-release tablets produced dose-related decreases in systolic and diastolic blood pressure as demonstrated in two double-blind, randomized, placebo-controlled trials in which over 350 patients were treated with nifedipine extended-release tablets 30,60 or 90 mg once daily for 6 weeks The mechanism by which nifedipine reduces arterial blood pressure involves peripheral arterial vasodilatation and, consequently, a reduction in peripheral vascular resistance Nifedipine is a peripheral arterial vasodilator which acts directly on vascular smooth muscle

Nifedipine is prescribed for elderly people with hypertension because it reduces arterial blood pressure through peripheral arterial vasodilatation and decreases peripheral vascular resistance.

• Key benefits of nifedipine for elderly patients with hypertension include:
  • Dose-related decreases in systolic and diastolic blood pressure
  • Reduction in peripheral vascular resistance
  • Peripheral arterial vasodilatation The clinical studies 2 and mechanism of action 2 support the use of nifedipine in elderly patients with hypertension.

From the Research

Nifedipine Prescription for Elderly People with Hypertension

• Nifedipine, a calcium channel blocker, is prescribed for elderly people with hypertension due to its effectiveness in lowering blood pressure 3, 4.
• The medication is particularly recommended for elderly patients with systolic hypertension, as it has been shown to prevent stroke in this population 4.
• Nifedipine is available in various formulations, including immediate-release and sustained-release forms, with the latter being preferred for elderly patients due to its smoother plasma concentration/time profile 4, 5.
• Studies have demonstrated the efficacy and safety of nifedipine in elderly patients, with significant decreases in blood pressure and improvements in cardiac function indices 3, 6.
• However, immediate-release nifedipine is generally not recommended for elderly patients due to the risk of adverse effects, such as myocardial ischemia 7, 5.

Safety and Efficacy Considerations

• Elderly patients with left ventricular hypertrophy (LVH) may be at increased risk of myocardial ischemia when taking nifedipine, even at low doses 7.
• Nifedipine has been shown to decrease myocardial lactate extraction in patients with LVH, indicating a potential risk of myocardial ischemia 7.
• Despite these risks, nifedipine can be an effective and well-tolerated treatment option for elderly patients with hypertension, particularly when used in a sustained-release formulation 3, 4, 6.

Clinical Use and Recommendations

• The INSIGHT study established that nifedipine GITS (gastrointestinal therapeutic system) decreased mortality and morbidity in hypertensive patients with additional risk factors, including elderly patients 4.
• Nifedipine GITS has also been shown to slow the progression of atherosclerosis in carotid and coronary arteries 4.
• However, the PRISCUS list recommends avoiding immediate-release nifedipine in elderly patients due to its potential risks, and instead suggests using alternative medications or formulations 5.