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Short- and long-term cerebrovascular effects of nitrendipine in hypertensive patients
1Department of Internal Medicine, Kantonsspital, Aarau, Switzerland.
Insights
Calcium antagonists like nifedipine effectively lower blood pressure (BP) in hypertensive emergencies, increasing cerebral blood flow (CBF). Chronic use in hypertension maintains BP reduction without altering CBF.
Area of Science:
- Cardiology
- Neurology
Background:
- Hypertension management requires understanding effects on blood pressure (BP) and cerebral blood flow (CBF).
- Calcium antagonists are used for both acute and chronic hypertension treatment.
Purpose of the Study:
- Evaluate acute and chronic effects of calcium antagonists on BP and CBF.
- Compare nifedipine and clonidine in hypertensive emergencies.
- Assess nitrendipine and verapamil in uncomplicated hypertension.
Main Methods:
- Randomized trials comparing oral nifedipine/intravenous clonidine for emergencies.
- Xenon-133 used to measure CBF.
- Four-week treatment with nitrendipine or verapamil, followed by washout and chlorthalidone.
- Short-term (2-hour) and long-term (6-week) nitrendipine effects measured.
Main Results:
- Nifedipine and clonidine significantly lowered BP in emergencies; nifedipine increased CBF, clonidine decreased it.
- Chronic nitrendipine, verapamil, and chlorthalidone significantly lowered BP with unchanged CBF.
- Acute nitrendipine lowered BP without changing CBF, indicating intact autoregulation.
Conclusions:
- Nifedipine's spasmolytic effect increases CBF in emergencies.
- Intact cerebral autoregulation preserves CBF during short- and long-term calcium antagonist treatment in hypertension.
Abstract:
The aim of our studies was to evaluate the effect of acute treatment in hypertensive emergencies and of chronic and acute treatment in uncomplicated hypertensives with calcium antagonists on blood pressure (BP) and cerebral blood flow (CBF). Ten patients with high blood pressure requiring emergency reduction were randomized to treatment with oral nifedipine or intravenous clonidine. The effect on CBF was investigated using xenon-133. Twenty-one patients with mild to moderate hypertension were randomly assigned to nitrendipine (n = 10) and to verapamil treatment for 4 weeks. After 14 days of washout, all patients received chlorthalidone for 4 weeks. CBF was measured before calcium antagonists, after 4 weeks, after washout, and after 4 weeks of chlorthalidone. Until now, five patients with mild to moderate hypertension entered in an ongoing study. After 14 days of placebo, CBF and BP reduction were measured 2 h and 6 weeks after nitrendipine. In hypertensive emergencies, nifedipine and clonidine lowered BP significantly, whereas CBF increased after nifedipine and decreased after clonidine. After chronic treatment with nitrendipine and verapamil and after chlorthalidone, the BP-lowering effect was significant whereas CBF remained unchanged. Two hours after nitrendipine, BP decreased and CBF remained unchanged. The reason for increasing CBF in hypertensive emergencies after nifedipine is due to its spasmolytic effect on cerebral vessels. The unchanged CBF after short- and long-term treatment with nitrendipine is due to the fact that in these patients the autoregulatory mechanism is intact.