Nifedipine: Is It a Good Drug for Hypertension?

The Bayer 1040 Experiment in 1963 gave birth to a new drug that promised great cardiological benefits and is still in use today: Nifedipine. In Germany, its creators S. Bossert and W. Vater synthesized it while studying new compounds that blocked calcium currents in the heart. Finally, in 1969, Dr. Fleckenstein confirmed the existence of this new pharmacological group called calcium antagonists.

Nifedipine is a vasodilator drug belonging to the group known as dihydropyridine calcium channel blockers. Its main properties were initially stipulated based on its coronary vasodilator effect, and it was extensively studied in acute coronary syndromes, especially those related to coronary spasm and peripheral vascular phenomena, such as Prinzmetal's Angina or Raynaud's phenomenon. Later clinical studies showed an increase in adverse events in coronary patients, especially those with ventricular dysfunction. Thus, its indications became contraindications, and its role was relegated to the management of arterial hypertension.

Is it a good drug for managing arterial hypertension today? The role of Nifedipine in hypertension management today is very limited. One of the few remaining indications is in pregnancy due to its safety for the fetus, although I believe there are better options available in 2024.

Why is its indication so limited? Because it is a very potent drug that causes rapid and intense drops in blood pressure, an effect that is no longer desired in the appropriate treatment of hypertension. Additionally, it has a very short half-life, meaning it must be taken at least three to four times a day due to its rapid metabolism, complicating adherence. What is adherence? It means the patient's ability to take the medication consistently and correctly every day. The more doses required per day, the lower the adherence and the worse the results in managing blood pressure. To address this issue, complex extended-release forms like the well-known Adalat Oros were created, allowing controlled release over time, significantly extending the dosing interval to 24 hours. This is a bioengineering solution for a drug that does not naturally possess these characteristics.

Is it a good drug for hypertensive crises/emergencies? In my opinion, it is not, similar to sublingual medications, as they produce a sudden drop in blood pressure. This type of response is undesirable and associated with severe events. We aim to lower blood pressure with drugs that have slower and more prolonged effects over time.

Is it a good drug for the treatment of primary hypertension? I believe there are many better options currently available, and this drug should never be considered a first choice.

Of course, it is important for each patient to consult their cardiologist for a detailed review and to obtain the best treatment for their cardiovascular condition.

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