scholarly journals Calcium-channel blockers for the prevention of stroke: from scientific evidences to the clinical practice

2013 ◽  
pp. 37-43
Author(s):  
S. Taddei
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Ventricular Hypertrophy ◽  
Blood Pressure Reduction ◽  
Left Ventricular ◽  
Channel Blockers ◽  
Pressure Reduction ◽  
Drug Classes

AIM OF THE REVIEW The present review aims to analyze the role of calcium-channel blockers, and particularly newer molecules, as first-line therapy for cerebrovascular disease. BACKGROUND Stroke is the leading cause of disability in the general population. Among traditional cardiovascular risk factors, hypertension has a key role in the genesis of both hemorrhagic and ischemic stroke and a direct correlation exists between blood pressure values and the risk of stroke. Moreover, blood pressure reduction has been demonstrated to be the most important route to reduce stroke incidence and recurrence. However, the mere reduction of blood pressure values does not normalize the cardiovascular risk of the hypertensive patient. It is therefore necessary to use drug classes that beyond their blood pressure-lowering effect have also an additional effect in terms of organ protection. Among these, calcium-channel blockers have a crucial profile. Firstly, they are effective in inducing left ventricular hypertrophy regression, with a strength at least equal to that of ACE-inhibitors. Secondly, they have an antithrombotic and an endothelium-protecting effect, mediated by their antioxidant activity. Finally, calcium-channel blockers are the most powerful drugs in preventing vascular remodeling. For these reasons this drug class has probably the strongest antiatherosclerotic effect, and it is the first-choice treatment mainly for cerebrovascular disease. Among different available calcium-channel blockers, the newer ones seem to possess pharmacokinetic characteristics allowing a more homogeneous 24 hours coverage as compared to older molecules, and preliminary data seem to suggest a greater beneficial effect also on left ventricular hypertrophy and lower incidence of side effects. CONCLUSIONS Although blood pressure reduction is the main tool to reduce cerebrovascular risk in hypertensive patients, some drug classes, such as calciumchannel blockers, seem to provide a protective action beyond the mere antihypertensive effect, and represent a key element in the prevention of atherosclerosis.

Abstract P140: Blood Pressure Control in Veterans Following Percutaneous Coronary Intervention (PCI)

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Sloane A McGraw ◽  
Michael Scholfield ◽  
Ragu Murthy ◽  
Burhan Mohamedali ◽  
Anupama Shivaraju ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Pressure Control ◽  
Joint National Committee ◽  
National Committee ◽  
Channel Blockers ◽  
Drug Classes

Background: Control of blood pressure (BP) in patients with underlying coronary artery disease (CAD) provides a decreased risk in morbidity and mortality. According to the US Joint National Committee VII (JNC-7) recommendations, patients with underlying CAD should have goal blood pressures of systolic <130 and diastolic <80. These goals can be attained by using multiple classes of drugs including beta-blockers (BB), angiotensin agonists (ACE-I/ARB), calcium channel blockers (CCB), diuretics and nitrates. Methods: We conducted a retrospective cohort study focusing on attaining JNC-7 guidelines for BP in a diverse population of 772 patients undergoing PCI between September 2004 and September 2008 at the Jesse Brown Veterans Hospital in Chicago, IL. Data was collected which compared both BP measurements and antihypertensive regimens pre and post PCI. Results: For the 772 patients, the overall population mean systolic blood pressure (SBP) decreased from 134 to 128mmHg (p < 0.0001) and mean diastolic blood pressure (DBP) decreased from 73 to 70mmHg (p < 0.0001). With regards to JNC-7 guidelines, the percent of patients who reached SBP goals increased from 44 to 54% (340 to 417 of 772) (p < 0.0001) and with DBP goals rose from 72 to 78% (556 to 602 of 772) (p = 0.0031). At 6 months, there was a statistically significant (all p values <0.0001) change in the use of each drug class; the use of ACE-I/ARB increased from 64% (494 out of 772) to 76% (587 of 772) and BB from 73% (564 of 772) to 89% (687 of 772). There was also increased utilization of diuretics 41% (317 of 772) to 43% (332 of 772) and nitrates 23% (178 of 772) to 29% (224 of 772), however a decrease in the use of calcium channel blockers, 34% (262 of 772) to 31% (239 of 772). Conclusions: There was improvement in BP in the six months after PCI and although there were higher rates of attainment of JNC-7 goals for SBP and DBP at six months, overall percentage values are still suboptimal. Additionally, the medication usage improved in most drug classes with exception of calcium channel blockers; however these increases still leave some room for improvement.

Effects of blood pressure reduction with trandolapril and enalapril on left ventricular hypertrophy and exercise tolerance

1993 ◽  
Vol 11 (5) ◽  
pp. S356???S357 ◽  
Author(s):  
Gastone Leonetti ◽  
Roberto Fogari ◽  
Carlo Mazzola ◽  
Carlo Pasotti ◽  
Gian Battista Ponti ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Left Ventricular Hypertrophy ◽  
Exercise Tolerance ◽  
Ventricular Hypertrophy ◽  
Blood Pressure Reduction ◽  
Left Ventricular ◽  
Pressure Reduction
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