Evaluation of the antihypertensive efficacy and safety of moxonidine in the treatment of uncomplicated hypertensive crisis

Abstract

Aim. To evaluate the clinical efficacy and safety of the selective imidazoline I1-receptor agonist moxonidine versus the angiotensin-converting enzyme inhibitor captopril in patients with uncomplicated hypertensive crisis (UHC). Subjects and methods. Two hundred and twenty-five patients (125 women, 100 men) aged 56,2±14,4 years with UHC were examined. The patients were randomized to a group of once-daily 0.4 mg moxonidine orally (n=113) and a group of once-daily 25 mg captopril (n=112). Dynamic measurements of blood pressure (BP) and heart rate, electrocardiogram recording, and determinations of blood creatinine, potassium, and glucose levels were made along with general clinical examination. The efficacy indices in patients were time to the onset of antihypertensive action, degree of BP lowering, and duration of antihypertensive effect. duration. 24-hour BP monitoring was used to evaluate the efficacy of the drugs compared. The time course of changes in the parameters was analyzed for 12 hours. Results. Both groups achieved an antihypertensive effect as a significant reduction in systolic and diastolic BP 30 and 60 min after therapy initiation, respectively; at the same time BP decreases did not exceed 25% of the baseline levels. Moxonidine was found to be more effective mainly in the duration of its antihypertensive effect with a steady BP decline throughout the follow-up. There was evidence that moxonidine exerted a positive metabolic effect, particularly in significantly reducing blood creatinine levels. In the moxonidine group, the patients with above satisfactory efficacy were 26,9% significantly more and those with above satisfactory tolerance were 18,8% more. Conclusion. The findings suggest that moxonidine versus captopril is highly effective and well tolerated in patients with UHC. The drug may be successfully used to treat UHC, starting in the prehospital period, especially in patients with concomitant diseases (diabetes mellitus, metabolic syndrome, chronic renal failure).