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Issue 8, 2007
HOT TOPICS IN CARDIOLOGY
Current concepts for achieving blood pressure goals: usefulness of dihydropyridines with a focus on barnidipine
| Publ. date: | 2007 |
| ISBN: | 978-88-89881-45-3 |
| ISSN: | 1973-9621 |
| E-ISSN: | 2036-0924 |
| DOI: | 10.4147/HTC-070800 |
Abstract
Calcium channel blockers have been used for more than a quarter of a century and are among the most widely prescribed drugs for the treatment of hypertension because of their well-established antihypertensive efficacy and their favorable impact on cardiovascular morbidity and mortality in hypertensive patients. These findings have been incorporated into the guidelines for hypertension management (ESH/ESC 2007), where calcium channel blockers are recommended as both monotherapy and in combination with other antihypertensive drugs, and are well established as first-line treatments.
In patients with established essential hypertension, it is mandatory to achieve adequate blood pressure control and integral protection of the increased global cardiovascular risk. Barnidipine is a new 1,4-dihydropyridine derivative and is the first drug of this class to be composed of a single optical isomer. Like other members of this drug class, barnidipine is selective for l-type calcium channels, with a high affinity for smooth muscles, leading to the marked vasodilation of peripheral and coronary arteries. Its antihypertensive action may also be partly due to its significant natriuretic effect.
This monograph reviews the usefulness of calcium channel blockers-with a focus on barnidipine-in attaining a better blood pressure control for patients in daily clinical practice.
Table of contents
Foreword
It is amply recognized that blood pressure control remains far removed from the goals recommended by international guidelines [1,2]. Rarely is a blood pressure control above 30% (with a goal of no less than 140/90 mmHg) seen in clinical settings [3].
Hospital-based hypertension units have witnessed values above 40% [4], and some clinical trials (for example, the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial [ALLHAT] [5]) have noted control values as high as 60%. According to international guidelines, if a goal lower than 130/80 mmHg was considered in hospitalbased hypertension units or in clinical trials (eg, when associated clinical conditions, diabetes, and chronic kidney disease are present), an adequate blood pressure control would be less than 20%.
In order to achieve a goal close to that proposed by the international guidelines, many drugs have been formulated. One such class-calcium channel blockers-are widely used for the treatment of cardiovascular disease, particularly angina pectoris, arrhythmias, and arterial hypertension. The three main classes of calcium channel blockers in current use are the benzothiazepines (diltiazem), phenylalkylamines (verapamil), and dihydropyridines (nifedipine, amlodipine, and others). Their beneficial effects are related to systemic vasodilation caused by the inhibition of the inward flow of calcium ions through the L-type calcium channels in the cell membrane. In hypertensive patients with or without chronic kidney disease, calcium channel blockers are excellent antihypertensive drugs. Moreover, considering that a high percentage of patients will require combination therapy to achieve an adequate blood pressure goal, dihydropyridine calcium channel blockers offer their synergistic blood-pressure-lowering effects with different antihypertensive agents.
REFERENCES
1. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003;289:2560-2571.
2. The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). 2007 Guidelines for the Management of Arterial Hypertension. J Hypertens 2007;25:1105-1187.
3. Borghi C, Dormi A, D'Addato S, Gaddi A, Ambrosioni E; and the Brisighella Heart Study Working Party. Trends in blood pressure control and antihypertensive treatment in clinical practice: the Brisighella Heart Study. J Hypertens 2004;22:1707-1716.
4. Banegas JR, Segura J, Ruilope LM, et al, on behalf of the CLUE Study Group Investigators. Blood pressure control and physician management of hypertension in hospital hypertension units in Spain. Hypertension 2004;43:1338-1344.
5. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA 2002;288:2981-2997.
ARTICLES
Current concepts for achieving blood pressure goals: usefulness of dihydropyridines, with a focus on barnidipine
Luis M. Ruilope, Julián Segura
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Editors-in-chief
Christopher P. Cannon - MD
Sergio Dalla Volta - MD, PhD
While cardiology over the last 15 years has progressed to a great extent in various aspects, it has not progressed in a harmonious manner. Advances in biophysics, molecular biology, genetics, and, les...
Past editor-in-chief
Philip A. Poole-Wilson - MD, FRCP, FACC, FESC, FMedSci
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