Cilnidipine shows promise as first-line antihypertensive, both in monotherapy or combination: Meta-analysis

Hypertension is one of the most common cardiovascular diseases, and the prevalence of hypertension continues to rise across the globe. National and international guidelines recommend angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), diuretics, and beta-blockers for the management of hypertension. CCBs are among the most used antihypertensive medications.

Cilnidipine is a newer dihydropyridine CCB shown to have a prolonged antihypertensive property, being a L/N-type calcium channel blocker, it lowers the BP in part by sympathetic nerve inhibition at the peripheral sympathetic nerve endings in vivo, and has reported a lower incidence of pedal edema compared to amlodipine.

With such background , the researchers under Chakraborty et al, aimed to carry out a meta-analysis of comparative randomized and non-randomized clinical trials evaluating the effect of Cilnidipine monotherapy or combination therapy on systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PR) over 48 weeks of therapy.

Study design consisted of searching PubMed (MEDLINE) and Google scholar databases to identify studies designed to evaluate the effects of Cilnidipine in the treatment of hypertensive patients. The study criteria for inclusion into the meta-analysis were all prospective, randomized, and non-randomized clinical studies published till March 2021, studies published in a peer-reviewed journal, the inclusion of patients with hypertension, assessment of blood pressure and heart rate, and a follow-up of four weeks or longer. The primary outcomes assessed were changes in SBP, DBP, and PR from baseline at the end of therapy compared between the Cilnidipine and other CCB's.

The key facts that were revealed have been summarized.

• The initial search identified 82 potential articles; of these, 24 met the inclusion criteria. Studies with <4 weeks treatment period and those not having a CCB were excluded.
• Cilnidipine caused a significant reduction (p<0.05) in SBP, DBP, and PR at end of therapy, whereas the reduction in SBP, DBP, and PR with Cilnidipine were similar to other CCB's (p>0.05).
• The results of this meta-analysis revealed that there were no significant differences in the efficacy in the treatment of hypertensive patients with Cilnidipine and the other therapies.

Observing the results, the team concluded that "We recommend Cilnidipine as a novel first-line CCB for the management of hypertension either as a monotherapy or as a combination therapy. Cilnidipine is highly lipophilic and shows low BP variability among CCBs. The organ protection, especially the reno-protective effect of Cilnidipine deserves special attention. In earlier trials, Cilnidipine was found to be safe and effective in reducing microalbuminuria in hypertensive patients. We warrant further studies to reinforce the cardio-protection and renoprotection efficacy of Cilnidipine, particularly in hypertensive diabetic patients."

For full article follow the link: DOI: 10.7759/cureus.19822

Source: Cureus