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Anti-atherosclerotic and vasculoprotective actions of calcium antagonists
1University of Texas Southwestern Medical Center, Dallas 75235-8899.
Insights
Newer antihypertensive calcium antagonists show promise in preventing atherosclerotic complications of hypertension, unlike traditional therapies. Ongoing studies aim to confirm their ability to manage both pressure-related and vascular disease aspects of hypertension.
Area of Science:
- Cardiology
- Pharmacology
- Vascular Medicine
Background:
- Hypertension treatment effectively reduces pressure-related complications like stroke.
- Traditional antihypertensives (diuretics, beta blockers) show limited success in mitigating atherosclerotic complications (e.g., coronary artery disease).
- Adverse metabolic effects and lack of vasoprotective properties in traditional therapies may explain their shortcomings.
Purpose of the Study:
- To evaluate the potential of newer antihypertensive agents, specifically calcium antagonists, in addressing the atherosclerotic complications of hypertension.
- To explore the antiatherosclerotic and antiatherogenic properties of calcium antagonists.
- To investigate if calcium antagonists can positively impact the course of vascular disease in hypertensive patients.
Main Methods:
- Review of experimental and clinical studies on calcium antagonists.
- Analysis of a specific clinical study comparing verapamil to conventional therapies for coronary artery disease progression.
- Mention of ongoing large-scale clinical trials (FIPS, MIDAS, INTACT, Montreal Heart Institute Study) evaluating calcium antagonists.
Main Results:
- Calcium antagonists demonstrate clear antiatherosclerotic properties in preclinical and clinical settings.
- One study showed verapamil slowed coronary artery disease development, reduced stenosis progression, increased regression rates, and decreased new lesions compared to conventional treatments.
- Ongoing trials utilize precise endpoints like myocardial infarction and cerebral infarction to assess antiatherogenic effects.
Conclusions:
- Calcium antagonists may offer a more comprehensive approach to hypertension management by targeting both pressure-related and atherosclerotic complications.
- These agents, with potentially fewer adverse effects and more physiologic mechanisms, could revolutionize hypertension treatment.
- Further results from ongoing studies are anticipated to confirm the role of calcium antagonists in managing the multifaceted aspects of hypertension.
Abstract:
Treatment of hypertension may prevent many of the complications attributable to blood pressure elevation, particularly those that are "pressure-related," such as stroke. However, the atherosclerotic complications of hypertension, e.g., coronary artery disease manifested as coronary morbidity and mortality, have not been reduced significantly with antihypertensive therapy. This disappointing outcome may reflect the adverse metabolic effects of the traditional therapies, diuretics and beta blockers, and their lack of specific vasoprotective properties. Increasing attention is thus being paid to the newer antihypertensive agents, which typically have fewer adverse effects and perhaps more physiologic mechanisms of antihypertensive action. Since calcium plays a key role in the genesis of atherosclerosis, calcium antagonists may positively affect the course of vascular disease. Investigators have observed that calcium antagonists display clear antiatherosclerotic properties in experimental as well as clinical studies. In one recently published clinical study, coronary artery disease was shown to develop more slowly, with a slower progression of individual stenoses, higher regression rate and less frequent occurrence of new lesions in patients treated chronically with verapamil compared to those receiving conventional therapies. Other similar investigations are currently under way to evaluate the antiatherogenic properties of calcium antagonists, including the Frankfurt Isoptin Progression Study (FIPS), the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS), the International Nifedipine Trial on Atherosclerosis Coronary Therapy (INTACT), and the large-scale Montreal Heart Institute Study. Results of these studies, which use precise end points such as myocardial infarction, cerebral infarction and peripheral vascular disease, may revolutionize the treatment of hypertension by identifying therapeutic approaches that control both the pressure-related and atherosclerotic complications of the disease.