Calcium Channel Blockers in Secondary Cardiovascular Prevention and Risk of Acute Events: Real-World Evidence from Nested Case–Control Studies on Italian Hypertensive Elderly (original) (raw)
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High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension, 2017
Essential hypertension is a complex clinical condition, characterized by multiple and concomitant abnormal activation of different regulatory and contra-regulatory pathophysiological mechanisms, leading to sustained increase of blood pressure (BP) levels. Asymptomatic rise of BP may, indeed, promote development and progression of hypertension-related organ damage, which in turn, increases the risk of major cardiovascular and cerebrovascular events. A progressive and independent relationship has been demonstrated between high BP levels and increased cardiovascular risk, even in the high-to-normal range. Conversely, evidence from randomized controlled clinical trials have independently shown that lowering BP to the recommended targets reduces individual cardiovascular risk, thus improving event-free survival and reducing the incidence of hypertension-related cardiovascular events. Despite these benefits, overall rates of BP control remain poor, worldwide. Currently available guideline...
Calcium channel blockers and cardiovascular outcomes: a meta-analysis of 175 634 patients
Journal of Hypertension, 2009
This review concluded that calcium channel blockers (CCBs) reduced risk of stroke and heart failure (compared to placebo) and dihydropyridine CCBs reduced risk of all-cause mortality (compared with active therapy) in high-risk cardiac patients. The reliability of these findings is unclear due to potential limitations in the data and methodology and the author's own reservations. Authors' objectives To evaluate the safety and effectiveness of calcium channel blockers compared to other drugs or placebo in reducing cardiovascular outcomes. Searching MEDLINE, The Cochrane Library and DARE, were searched up to May 2008 for publications in any language. Bibliographies of each retrieved article were handsearched. Some more recent publications were identified via colleagues. Search terms were reported. Study selection Randomised controlled trials (RCTs) that compared long-acting calcium channel blockers (CCB) with another hypertensive drug or placebo with assessment of cardiovascular events were eligible for inclusion. Trials that included patients selected on the basis of high blood pressure, diabetes mellitus, coronary heart disease, heart failure, peripheral vascular disease, cerebrovascular disease or renal disease were eligible for inclusion.
Use of Calcium Channel Blockers in Cardiovascular Risk Reduction
American Journal Cardiovascular Drugs, 2010
Cardiovascular disease (CVD) is a continuum that begins with the presence of several risk factors for CVD, including smoking, hypertension, obesity, diabetes mellitus, and high levels of cholesterol, and if unaddressed can result in premature death, ischemic heart disease, stroke, congestive heart failure, and endstage renal disease. Hypertension is associated with a significant increase in cardiovascular (CV) morbidity and mortality, raising the risk of stroke, myocardial infarction, heart failure, kidney disease, and peripheral arterial disease. In Latin America, the prevalence of hypertension and other CV risk factors has become similar to that seen in more developed countries, increasing the proportion of the population at high risk for CVD and congestive heart failure; however, it is hypertension that is a key driving force behind CV risk in Latin America. Despite the existence of a wide range of antihypertensive agents, BP control and reductions in CV risk remain poor in Latin America and in Hispanics living in the US. Ethnic differences in treatment rates and disease awareness have been well documented. Studies have shown that calcium channel blockers (CCBs; calcium channel antagonists) are at least as effective in reducing BP and improving the CV risk profile as other classes of antihypertensive agents when administered as monotherapy. CCBs have also been shown to be effective when administered as part of combination therapy in both low-and high-risk hypertensive patients, suggesting that CCBs can easily be combined with other antihypertensive classes in order to achieve BP control and CV risk reduction. In patients with hypertension, coronary artery disease, and high cholesterol, CCBs have been associated with beneficial effects on a range of other aspects of the CV continuum, including the vasculature, coronary calcification, and progression of atherosclerosis. CCBs have also been shown to preserve renal function. Unlike diuretics and b-adrenoreceptor antagonists, CCBs are
Calcium Channel Blocker Toxicity: A Practical Approach
Journal of Multidisciplinary Healthcare
Calcium channel blockers (CCBs) are widely prescribed medications for various clinical indications in adults and children. They are available in both immediate and long-acting formulations and are generally classified into dihydropyridines and nondihydropyridines, with nondihydropyridines having more cardioselectivity. CCB toxicity is common given the widespread use which leads to serious adverse clinical outcomes, especially in children. Severe CCB toxicities may present with life-threatening bradycardia, hypotension, hyperglycemia, and renal insufficiency. Dihydropyridine toxicity, however, may present with reflex tachycardia instead of bradycardia. Initial patient evaluation and assessment are crucial to identify the severity of CCB toxicity and design the best management strategy. There are different strategies to overcome CCB toxicity that requires precise dosing and close monitoring in various patient populations. These strategies may include large volumes of IV fluids, calcium salts, high insulin euglycemia therapy (HIET), and vasopressors. We hereby summarize the evidence behind the management of CCB toxicity and present a practical guide for clinicians to overcome this common drug toxicity.
Journal of Evidence Based Medicine and Healthcare
BACKGROUND Calcium channel blockers (CCB) like amlodipine, S (-) amlodipine and cilnidipine, etc. have established place in the treatment of hypertension (HTN). As perceived by most of the physicians, they have comparative antihypertensive efficacy. However, available evidences suggest varied differences in incidence of pedal oedema. Aim-This survey was planned to understand real-world clinical practice pattern of Indian physicians for usage of various antihypertensive agents with emphasis on CCBs and whether differential incidence of oedema with CCBs is encountered in their clinical practice. MATERIALS AND METHODS Survey questionnaire consisting of 10 questions about preferred antihypertensive choice for different subsets of patients with HTN and efficacy and safety of S (-) amlodipine was prepared and validated in small group of physicians. Overall, 494 general physicians and cardiologists practising in India were approached for seeking their opinion on usage of various CCBs. Statistical Analysis-Data were expressed in percentage. Design-Prospective, cross sectional, questionnaire-based survey. RESULTS Amongst various anti-hypertensive agents, majority of the physicians preferred CCB as their initial drug of choice for patients with HTN (53.8%), HTN with CKD (41.1%), elderly (55.3%), and young (30.8%) patients. Though amlodipine was preferred by 75.7% physicians, pedal oedema was observed in >10% patients by 40.5% physicians. Most of the physicians rated S (-) amlodipine to have better efficacy (79.4%) and safety profile (88.3%) with decreased incidence of pedal oedema than racemic Amlodipine. CONCLUSION Available evidences suggest comparative efficacy of S (-) amlodipine and racemic amlodipine with varied differences in incidence of pedal oedema. However, our survey suggests better efficacy and safety of S (-) amlodipine over racemic amlodipine as opined by most of the physicians of India. The survey findings need to be further evaluated in randomised clinical trials.
Hypertension Research, 2011
Dihydropyridine calcium channel blockers (CCBs) are widely prescribed for the management of hypertension in Eastern Asians. In this study, the Asian Pacific Heart Association's Writing Committee reviewed randomized controlled trials that were conducted in the Eastern Asian region and compared a CCB with an antihypertensive drug of another class. These trials studied ambulatory blood pressure, measures of target organ damage and cardiovascular events as outcomes. Eleven trials studied ambulatory blood pressure in hypertensive patients and demonstrated that the 24-h blood pressure reduction with CCBs was greater than with other classes of antihypertensive drugs, with a weighted mean difference of 5 mm Hg systolic and 3 mm Hg diastolic. Twelve trials that studied various measurements of target organ damage in hypertensive patients produced inconsistent results when comparing CCBs and other classes of antihypertensive drugs. Four trials that studied the hard outcomes had limited power, but confirmed the findings of previous placebo-controlled trials in the region and actively controlled trials in Europe and North America; they suggested that CCBs provided superior protection against stroke and that some agents, such as amlodipine, also provided similar protection against myocardial infarction. In conclusion, CCBs should be recommended as a preferred drug for the management of hypertension in the Eastern Asian region to improve blood pressure control and to confront the aggravating epidemic of stroke and coronary heart disease.