Adalat

[sandra kimmel]

I was prescribed Adalat 60 mg. for aortic insufficiency, mod. to severe, and at first seemed to develop gastric symptoms that resulted in gastritis.

When I asked to be put on another drug, my cardiologist kept insisting that I stick with the Adalat as this is the "treatment of choice" for this condition.  Luckily, my gastric symptoms cleared up after about 5 weeks and taking medication for my gastritis.

What does my cardiologist mean when he says that Adalat is the "treatment of choice for this condition?"  Wouldn't any medication that lowers blood pressure help this condition by helping the heart not pump as hard?  What is the preferred blood pressure -- mine is about 125/77 or in that area.  

Could Adalat keep my condition from worsening so that surgery would not be necessary for years? Right now I am asymptomatic except for pvc's.

Also, what should I be doing as far as diet, exercise, stress reduction to help keep my heart in tip-top shape in lieu of the bad valve?  

Thank you for your response.

[Cleveland Clinic, MD]

Here is the actual article reference: 1. Scognamiglio R, Rahimtoola SH, Fasoli G, Nistri S, Dalla Volta S. Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function. N Engl J Med 1994;331:689-94.

I would interpret the results of this article with caution.

[Reply to CCF]

The article said that researchers at the University of Padua in Italy reported in a recent issue of the New England Journal of Medicine that they found the drug nifedipine to be effective in reducing the need for surgery in people with severe aortic regurgitation.  It also stated that while an editorial accompanying the New England Journal article hailed the Padua findings as a "major advance" it will be years before further studies have tested these preliminary results sufficiently to know whether this is, indeed the advance that it appears to be.  It further states the the study does underscore two important points about medical research -- that all advances don't involve something new, high-tech and costly, and that serendipity -- finding one thing in the course of searching for another -- remains one of the great sources of scientific advancement.
It says 1999 Cardiovascular Institute of the South.  The web site http://www.cardio.com/articles/nifedipn.htm.

Please let me know what you think.

I'm very curious and hopeful as this is the drug I'm on for
mod. to sev. insuff. and I really hope I see good results as per the article!!

Thanks, you're great!!

[Cleveland Clinic, MD]

Could you give me the source for that study?  I'm not sure that comparing it to digitalis is a fair study but if it reduces the need for surgery that is a good thing.  In general however surgery is required for severe regurgitation.

[Comment to CCF]

In further investing Adalat on the Internet, I found information that stated that a study was done by researchers at the University of Padua in Italy and that they found the drug nifedipine to be effective in reducing the need for surgery in people with severe aortic regurgitation.  It said if the Italian study's findings are borne out in clinical research in this country, the deterioration that makes surgery necessary may be slowed considerably.  NOne of the patients receiving nifedipine in this study needed surgery in the first two years of treatment, and only 15 percent needed surgery during the entire six-year period during which they were followed.  By contract, 35 percent of the patients given digitalis needed surgery during the course of the study.

I will run this by my cardiologist on my next visit to see if this is what he meant by "treatment of choice" for this condition.

I just wondered what your opinion was on this.

Thanks!!

[Cleveland Clinic, MD]

I'm not sure what your doctor meant by that statement.  You could ask him about it at your next visit.