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Impact of calcium antagonists on the cardiovascular system: experience with lacidipine
1National University of Córdoba, Argentina.
Insights
Lacidipine treatment improves cardiac function and reduces blood pressure in elderly hypertensive patients. This antihypertensive therapy enhances cardiac output and left ventricular ejection fraction, offering a beneficial treatment option.
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Background:
- Hypertension presents distinct hemodynamic patterns in younger versus older adults.
- Elderly hypertensive patients exhibit reduced cardiac function and increased peripheral resistance.
- Understanding these age-related differences is crucial for effective antihypertensive treatment.
Purpose of the Study:
- To evaluate the hemodynamic effects of lacidipine in elderly hypertensive patients.
- To compare lacidipine's efficacy with other long-acting dihydropyridines.
- To assess lacidipine's impact on left ventricular function and myocardial blood flow.
Main Methods:
- Radionuclide techniques and tomographic gamma camera imaging were used.
- Elderly hypertensive patients received lacidipine (4 mg/day for 90 days).
- Hemodynamic parameters, cardiac reserve, and left ventricular function were assessed at rest and during exercise.
Main Results:
- Lacidipine significantly reduced blood pressure and total peripheral resistance.
- Treatment increased cardiac output and left ventricular ejection fraction (LVEF) towards normal.
- Lacidipine improved systolic and diastolic cardiac reserve and increased myocardial blood flow.
Conclusions:
- Lacidipine effectively improves hemodynamic profiles in elderly hypertensive patients.
- Its vasodilatory and anti-ischemic properties make it suitable for managing hypertension.
- Lacidipine demonstrates benefits in reducing left ventricular hypertrophy and improving cardiac function.
Abstract:
The evaluation of haemodynamic patterns in hypertensive patients by radionuclide techniques and a tomographic gamma camera has revealed differences between older and younger patients. In younger hypertensive patients, the hyperkinetic state is reflected in an increase in heart rate and, consequently, an increased cardiac index and left ventricular ejection fraction (LVEF) in comparison with normotensive controls. Older hypertensive patients, however, show a different haemodynamic pattern, with reduced systolic and diastolic function at rest compared with normotensive elderly people, and marked depression of cardiac reserve during exercise. Elderly hypertensive patients also show strikingly higher hyperresistance and reduced peripheral perfusion in comparison with younger hypertensive patients. These haemodynamic differences need to be taken into account when considering antihypertensive treatment. In a study in elderly hypertensive patients, lacidipine treatment (4 mg/day for 90 days) produced a significant decrease in total peripheral resistance and blood pressure, together with a reduction in left ventricular (LV) afterload and an increase in cardiac output and LVEF (tending towards normal values). The LV peak filling rate was also increased, and evaluation of systolic and diastolic cardiac reserve during exercise showed positive changes in cardiac performance. The haemodynamic changes with lacidipine were similar to those produced by other long-acting dihydropyridines [nifedipine gastrointestinal therapeutic system (GITS) and nitrendipine], but changes occurring with nisoldipine were less significant. The reduction in left ventricular hypertrophy (LVH) is an obvious goal of antihypertensive therapy, and several studies have demonstrated the effectiveness of lacidipine treatment in decreasing LVH in hypertensive patients. In hypertensive patients with associated LV dysfunction, favourable effects on global parameters of LV function similar to those with amlodipine have been noted with lacidipine. Myocardial blood flow was strikingly increased during lacidipine treatment and coronary resistance was significantly decreased, both at baseline and after maximal vasodilatation with dipyridamole. Thus, lacidipine's vasodilatory and anti-ischaemic profile makes it an appropriate choice for the treatment of hypertension.