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Effects of antihypertensive therapy on cardiac function
1Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas 75235-9030.
Insights
Hypertension treatment trials failed to prevent heart disease deaths. New therapies focus on vasodilators like calcium channel blockers, with nicardipine being a favorable option due to its lack of negative inotropic effects.
Area of Science:
- Cardiovascular medicine
- Pharmacology
Background:
- Clinical trials for hypertension treatment have not demonstrated protection against coronary heart disease mortality.
- Concerns exist regarding lipid disturbances with diuretics and non-intrinsic sympathomimetic activity (ISA) beta-blockers.
- Negative inotropic effects of beta-blockers are also a significant concern in hypertension management.
Purpose of the Study:
- To re-evaluate the indications and therapeutic strategies for hypertension management.
- To explore the suitability of vasodilators as a primary treatment modality.
- To identify specific calcium channel blockers with favorable safety profiles.
Main Methods:
- Review of existing clinical trial data and pharmacological profiles of antihypertensive agents.
- Comparative analysis of different drug classes, including vasodilators (alpha-blockers, ACE inhibitors, calcium channel blockers).
- Focus on the specific properties of calcium channel blockers, particularly nicardipine.
Main Results:
- Widespread use of vasodilators is suggested as an appropriate therapeutic approach.
- Nicardipine emerges as a promising calcium channel blocker.
- Nicardipine's lack of negative inotropism is a key advantageous characteristic.
Conclusions:
- Reconsideration of hypertension treatment is necessary due to trial outcome failures.
- Vasodilators, especially calcium channel blockers like nicardipine, offer a potentially safer alternative.
- Nicardipine's profile makes it an attractive option for managing hypertension, particularly concerning cardiac function.
Abstract:
The failure of clinical trials in the treatment of hypertension to show protection against mortality from coronary heart disease has prompted a major reconsideration of the indications and modes of therapy. One area of concern is the lipid disturbances seen with diuretics and non-ISA (intrinsic sympathomimetic activity) beta blockers; another is the negative inotropic effect of beta blockers. The more widespread use of vasodilators--either alpha-blockers, angiotensin-converting enzyme (ACE) inhibitors, or calcium channel blockers--therefore seems appropriate. Among the calcium channel blockers, nicardipine appears to be a particularly attractive choice, in part because of its lack of negative inotropism.