Effects of barnidipine in comparison withhydrochlorothiazide on endothelial function, as assessed by flow mediated vasodilatation in hypertensive patients.

Background. In hypertensive patients, endothelial dysfunction is associated with an increased incidence of cardiovascular events. Calcium-channel antagonists can reverse impaired endothelium-dependent vasodilation in different vascular districts, while confl icting results are found in the brachial artery. Aim. To investigate the effect of barnidipine in comparison with hydrochlorothiazide on endothelial function of hypertensives, as assessed by fl ow-mediated vasodilation (FMD) of the brachial artery. Methods. Patients with mild to moderate hypertension (age range 26 – 67 years) were randomized to receive barnidipine or hydrochlorothiazide. A thorough clinical examination, including blood pressure (BP) measurement, was performed at randomization as well as after 6, 12 and 24 weeks. FMD and 24-h BP monitoring was performed at randomization, after 12 and 24 weeks. Results. After 12 and 24 weeks of treatment, a signifi cant reduction in clinic BP was observed in both groups. Furthermore, a signifi cant reduction in 24-h SBP and DBP was observed in patients receiving barnidipine but not in those receiving diuretic. The percentage change in FMD was different between the two groups of patients treated with barnidipine (at 12 weeks 1.2 2.2%, p 0.023 and at 24 weeks 1.25 3.15%, p 0.16 from baseline) or with hydrochlorothiazide (at 12 weeks 1.0 3.0. p 0.09 and at 24 weeks 1.78 2.9%, p 0.015 from baseline). A signifi cant difference in FMD changes between the two groups was confi rmed by analysis of covariance ( p 0.031). Conclusions. In presence of a similar clinic BP reduction, an improvement of endothelial function was observed during treatment with barnidipine but not with hydrochlorothiazide, suggesting that the barnidipine may exert a favourable effect on endothelial dysfunction in hypertensive patients.