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Potential beneficial effects of urapidil in primary and secondary prevention of stroke
1Department of Internal Medicine I (Cardiology), City Hospital Krefeld, Germany.
Insights
Urapidil effectively reduces cardiovascular risk in hypertensive patients, showing promise for acute stroke treatment and secondary prevention. This antihypertensive agent also improves lipid profiles and brain
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- Stroke is a significant neurological disease with substantial economic costs, necessitating effective prevention and acute treatment strategies.
- Hypertension negatively impacts cerebral autoregulation, highlighting the need for antihypertensive therapies that also address atherogenesis and maintain cerebral blood flow.
- Current stroke management requires avoiding increased intracranial pressure during acute phases and enhancing ischemic tolerance.
Purpose of the Study:
- To evaluate the potential benefits of urapidil in the acute phase of stroke and for secondary stroke prevention.
- To assess urapidil's effects on cardiovascular risk factors, including lipid profile, glucose metabolism, and platelet aggregation in hypertensive patients.
Main Methods:
- Urapidil, an alpha 1-adrenoceptor blocker with central sympathoinhibitory effects, was administered at 60 mg twice daily for 3 years.
- Studies included assessment of cardiovascular risk reduction, influence on lipid profiles, glucose metabolism, and platelet aggregation.
- Animal experiments were conducted to evaluate urapidil's effect on brain ischemic tolerance.
Main Results:
- Three years of urapidil treatment reduced total cardiovascular risk by 26% in hypertensive patients.
- Urapidil demonstrated favorable effects on lipid profiles, glucose metabolism, and platelet aggregation.
- Animal studies indicated that urapidil can improve the brain's tolerance to ischemia.
Conclusions:
- Urapidil is an effective antihypertensive agent with beneficial effects on cardiovascular risk factors relevant to stroke.
- The findings suggest urapidil warrants further investigation for its potential role in acute stroke treatment and secondary prevention.
- Urapidil's ability to improve ischemic tolerance further supports its potential therapeutic value in stroke management.
Abstract:
Stroke is a partly preventable neurological disease associated with excessive economic cost. Adequate prevention of stroke and sufficient therapy in the acute phase will help to reduce the heavy burden of morbidity and severe economic impact. Hypertension as such, and even more so stroke itself, are known to influence cerebral autoregulation in a negative sense. With respect to the prevention of stroke, antihypertensive therapy should be accompanied by attempts to inhibit of atherogenesis, for instance via improvements of the lipid profile (lowering of LDL, elevation of HDL) or via inhibition of platelet aggregation. In conditions of acute stroke, a pharmacologically induced rise in intracranial pressure should be avoided, whereas cerebral perfusion pressure must be maintained. If possible, ischaemic tolerance should be increased. Also with respect to the secondary prevention of stroke, antihypertensive therapy should be aiming at maintaining cerebral blood flow, whereas the progression of atherosclerotic lesions should be impaired as much as possible. Urapidil may be characterised as a peripheral alpha 1-adrenoceptor blocker with additional sympathoinhibitory effect, triggered by the stimulation of central 5HT1A-receptors. Urapidil, well documented as an effective antihypertensive agent in short- and long-term trials, also showed beneficial influence in the acute phase of stroke. After 3 years of treatment with urapidil (60 mg b.i.d.), the total cardiovascular risk proved reduced by 26%. In addition, urapidil influenced lipid profile, glucose metabolism, and platelet aggregation favourably in hypertensive patients. In animal experiments, urapidil improved the ischaemic tolerance of the brain. Taken together it would seem worthwhile to investigate urapidil as a possibly beneficial agent in the treatment of acute stroke, as well as in secondary prevention of this condition.