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PubMed2006

Cardiorenal protective effects of year-long antihypertensive therapy with an angiotensin-converting enzyme inhibitor or a calcium channel blocker in spontaneously hypertensive rats.

BACKGROUND: The objective of this study was to evaluate the effect of year-long antihypertensive therapy with a calcium channel blocker and an angiotensin-converting enzyme (ACE) inhibitor on cardiac and renal injury. METHODS: Male 15-week-old spontaneously hypertensive rats (SHR) were given either a normal diet and normal drinking water (n = 10), a diet containing 0.05% nitrendipine (n = 10), or drinking water containing 50 mg/L of quinapril (n = 10). After 12 months of antihypertensive treatment, cardiovascular organ injuries were evaluated. RESULTS: Tail-cuff blood pressure (BP) at 12 months was significantly lower in animals receiving nitrendipine or quinapril than in control animals (control, 231 +/- 2 mm Hg; nitrendipine, 194 +/- 3 mm Hg; quinapril, 191 +/- 3 mm Hg; P < .001). Furthermore, aortic thickness was reduced by nitrendipine (-19%, P < .001) or quinapril (-21%, P < .001), and cardiac ventricular weight was significantly reduced by quinapril (-18%, P < .001) but not by nitrendipine (-5%, P = not significant [NS]). Echocardiography at 12 months revealed that midwall fractional shortening was higher in the quinapril group than in the control or the nitrendipine groups (control, 9.3% +/- 0.5%; nitrendipine, 9.8% +/- 0.5%; quinapril, 10.6% +/- 0.6%; P < .05). Left ventricular hydroxyproline levels were lower in the nitrendipine group (-21%, P < .01) and the quinapril group (-36%, P < .001) than in the control animals. In control SHR, creatinine clearance began to decrease and proteinuria began to increase at 6 to 9 months. Quinapril but not nitrendipine attenuated these markers of renal impairment (creatinine clearance at 12 months: control, 4.7 +/- 0.4 mL/min/kg; nitrendipine, 5.0 +/- 0.4 mL/min/kg; quinapril, 6.1 +/- 0.4 mL/min/kg; P < .05). Histologically, the glomerular injury score was lower in the quinapril group than in the control or nitrendipine groups (control, 19 [range, 8 to 30]; nitrendipine, 18 [range, 9 to 32]; quinapril, 7 [range, 3 to 12]; P < .01). CONCLUSIONS: It is suggested that year-long antihypertensive therapy with an angiotensin-converting enzyme (ACE) inhibitor is superior to a calcium channel blocker in terms of cardiorenal protection in SHR.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1995

Two stable cell lines for screening of calcium channel blockers.

Stable cell lines are potentially excellent tools for large-scale screening of new compounds. Two carboxyterminal-deleted constructs of the two splice variants a and b of the calcium channel class C alpha 1 subunit were expressed stably in HEK 293 cells. Each cell line produced regular L-type calcium currents. The opening and closing of the calcium channel elicited by potassium depolarization was followed by Fura-2 transients. These transients were blocked by the calcium channel blocker mibefradil with a concentration for 50% inhibition of 1.7 microM. The cell lines expressing the truncated cardiac alpha 1C-a or smooth muscle alpha 1C-b calcium channel were both blocked by nisoldipine under patch clamp conditions. Nisoldipine interacted with higher affinity with the alpha 1C-b channel than with the alpha 1C-a channel. These results indicate that the two cell lines retain the differential dihydropyridine sensitivity of smooth muscle and cardiac calcium channels and may be potential tools for the screening of L-type calcium channel blockers.

Benzimidazoles↗
PubMed1991

Nilvadipine, a new calcium channel blocker, reduces ischemic brain injury in rats.

The effects of nilvadipine, a dihydropyridine type calcium channel blocker, on cerebral infarction induced by focal brain ischemia was studied in rats. The area of infarction was measured 24 hr after occlusion of the middle cerebral artery (MCA) in spontaneously hypertensive rats using triphenyltetrazolium chloride. Nilvadipine, given immediately after MCA occlusion, reduced the area of infarction significantly at doses of 0.32 mg/kg (i.p.) and 3.2, 10 and 32 mg/kg (p.o.). Nicardipine suppressed the area of infarction at a dose of 32 mg/kg (p.o.). The results suggest that nilvadipine is effective against ischemic brain injury.

Animals↗
PubMed1991

Evidence for a central component in the cardiovascular effects of calcium channel blockers.

The possibility of a central component in the cardiovascular effects of peripherally administered calcium channel blockers has been explored through a comparison of the effects observed after intravenous (i.v.) and intracisternal (i.c.) administration of verapamil and diltiazem in chloralose-anesthetized and artificially ventilated cats. Both agents produced relatively greater effects after i.c. than after i.v. administration. The bradycardiac effect following i.c. as well as i.v. administration was totally abolished by bilateral cervical vagotomy, and the hypotensive effect was attenuated by this procedure. The results strongly suggest the existence of a central component in the cardiovascular effects of both agents.

Animals↗
PubMed1989

Effects of calcium channel blockers on in vivo cellular immunity in mice.

In vitro studies have shown that calcium channel blockers (CCB) inhibit lectin-induced lymphocyte proliferation. However, no in vivo effects have been documented yet. In this study we evaluated the effects of CCB on in vivo cellular immunity by using contact sensitivity to oxazolone in mice. From 15 to 30 twelve-week-old female C3H mice were randomized into: 0.9 NS (sham), ethanol, CsA, dexamethasone (DXM), verapamil, diltiazem, and nifedipine groups. These study agents were given daily from day 1 to day 9 subcutaneously to the shaved abdominal wall. The mice were sensitized with oxazolone to the abdominal wall on day 2 and challenged with oxazolone on the right ear on day 8. Delayed-type hypersensitivity was measured on day 10 and defined as the difference in thickness between the right (challenged) and left (control) ear of each mouse. The mean DTH of each study group was compared with that of the sham, and the statistical significance was determined by a Student's t test. The percentage of change in DTH from the sham was also calculated as: (mean DTH of study drug group-mean DTH of sham group)/mean DTH of sham group x 100%. A negative value meant a suppressive effect on DTH; a positive value, an enhancing one. The CsA, DXM, and nifedipine all had significant suppressive effects on DTH. Verapamil had a significant enhancing effect. Ethanol and diltiazem had no significant effect. More studies employing other antigens with several other cell-mediated response measurements along with DTH quantification should be done in order to determine the specificity of the immunosuppressive effect of CCB as well as the potential of any calcium antagonist as an adjuvant suppressive agent.

Animals↗
PubMed2000

Alcohol-induced reductions in cardiac protein synthesis in vivo are not ameliorated by treatment with the dihydropyridine calcium channel blocker amlodipine.

BACKGROUND: Various studies have indicated that acute ethanol dosage perturbs cardiac function and/or structure with concomitant reductions in protein synthesis. Cellular calcium homeostasis is also perturbed, which may contribute to altered protein synthesis. This is supported by the observation that calcium channel blockers can prevent numerous features of alcohol-induced pathology. However, many of these studies have been carried out in vitro, employing supraphysiological levels of alcohol, or have failed to address whether their results obtained in isolated systems have direct relevance in vivo. The aim of the present investigation was to examine the response of cardiac protein synthesis in vivo due to a physiologically relevant dose of ethanol and determine whether a calcium channel antagonist could prevent these effects. METHODS: Changes in cardiac protein synthesis rates in vivo were assessed by measuring the fractional rates of protein synthesis (i.e., ks) using a "flooding dose" of [3H]phenylalanine. Rats were treated either acutely (10 mg/kg body weight, 3 hr) or chronically (10 mg/kg body weight/day, 30 days) with amlodipine, a dihydropyridine-type calcium channel blocker, before dosing with ethanol (75 mmol/kg body weight, 2.5 hr). RESULTS: Ethanol (75 mmol/kg body weight) inhibited cardiac protein synthesis after 1 hr. Similar responses were recorded at 2.5 and 6 hr after ethanol dosage. At 24 hr, ethanol decreased food intakes. However, a direct comparison between pair-fed controls and alcohol-dosed rats also showed a decrease in cardiac protein synthesis after 24 hr. Acute alcohol dosage reduced cardiac protein synthesis in mixed, myofibrillary, and sarcoplasmic protein fractions. Similar results were obtained when data were expressed relative to ribonucleic acid (i.e., kRNA). Neither acute nor chronic treatments with the calcium antagonist amlodipine ameliorated the deleterious actions of ethanol on protein synthesis. CONCLUSIONS: Ethanol may affect cardiac protein synthesis independently of altered calcium entry.

Amlodipine↗
PubMed1986

Migraine treatment with calcium channel blockers.

Irrespective of their mechanism of action, which so far has not been clarified, calcium channel blockers (CCBs) have a documented prophylactic effect on classical and common migraine, as well as on cluster headache. The drugs may reduce migraine prodromes, the frequency of migraine attacks, and also decrease the severity and possibly the duration of these attacks. Notably, their optimum effect is often seen after more than 2 months of treatment. Side effects seem to be few and mild. Whether or not there are differences in therapeutic efficacy between different CCBs is presently unclear. As comparisons with other alternatives of treatment are sparse, the place of CCBs in migraine therapy remains to be established.

Animals↗
PubMed1993

Biochemical, structural and ultrastructural changes in the Prague hereditary hypercholesterolemic (PHHC) rats heart after the long treatment with calcium channel blockers.

Elevated plasma cholesterol concentration may be important in the initiation of heart ischemia and progression of atherogenesis. It has been shown that drugs affecting calcium entry into cells can attenuate the development of this cholesterol induced changes. The aim of this work was to study the influence of five calcium channel blockers 6 weeks treatment on some parameters of lipid metabolism, morphological and ultrastructural changes in the Prague hereditary hypercholesterolemic (PHHC) rats myocardium. The calcium antagonists were administered twice daily perorally in the following doses: nifedipine and nitrendipine 0.2 mg.kg-1, nimodipine 2.5 mg.kg-1, verapamil and diltiazem 1.0 mg.kg-1 body weight. Cholesterol diet decreased the level of free fatty acids significantly (from 5.59 +/- 0.216 to 3.83 +/- 0.371 mumol.g-1), increased the level of total cholesterol (from 28.0 +/- 1.92 to 34.0 +/- 2.90 mumol.g-1) and caused micronecrosis. Examination of myocardial ultrastructure showed a frequent occurrence of lysosomes as well as large numerous autophagic vacuoles and contracture bands of myofibrils. These effects were partly suppressed by calcium channel blockers verapamil and diltiazem, but dihydropyridines were not effective. Observed biochemical changes were in accordance with structural and ultrastructural investigations.

Animals↗
PubMed1986

Disparate effects of the calcium-channel blockers, nifedipine and verapamil, on alpha 2-adrenergic receptors and thromboxane A2-induced aggregation of human platelets.

Calcium-channel blockers inhibit human platelet aggregation in vitro and ex vivo. To further evaluate the mechanism(s) responsible for the inhibition induced by this structurally heterogeneous group of compounds, we studied the effect of nifedipine and verapamil on human platelet aggregation in vitro. Neither 10 microM nifedipine nor 10 microM verapamil consistently inhibited the aggregation response of platelet-rich plasma to threshold concentrations of ADP, sodium arachidonate, epinephrine, or collagen. However, both 10 microM nifedipine and 10 microM verapamil epinephrine-potentiated, thromboxane A2 (TXA2)-induced aggregation of aspirin-incubated, gel-filtered platelets. Aggregation of similarly prepared platelets induced by TXA2 alone was abolished by 10 microM nifedipine but not by 10 microM verapamil. Even 100 microM verapamil gave only partial and inconsistent inhibition of aggregation. Both drugs had essentially the same effects on platelet aggregation induced by the stable endoperoxide and TXA2 mimic, U46619, with or without epinephrine. Neither 10 microM nifedipine nor 10 microM verapamil elevated platelet cyclic AMP. Verapamil (10 microM) inhibited binding of [3H]-yohimbine (an alpha 2-adrenergic receptor antagonist) to intact human platelets (KD 10.5 nM vs 2.4 nM for control platelets) without altering the number of binding sites. In contrast, 10 microM nifedipine had no effect on KD or number of binding sites. These results indicate that nifedipine and verapamil inhibit epinephrine-potentiated, TXA2-induced human platelet aggregation by different mechanisms. Verapamil inhibits the epinephrine contribution to the aggregation response by blocking alpha 2-adrenergic receptor binding. Nifedipine blocks the platelet response to TXA2 without affecting alpha-adrenergic receptor binding. These observations have potential clinical implications with regard to the mechanisms by which calcium-channel blockers inhibit vascular spasm and myocardial ischemia.

Adenosine Diphosphate↗
PubMed1998

[Calcium channel blockers in the treatment of hypertension and ischemic coronary disease. Conflicts in their evaluation].

Calcium channel blockers represent a pharmacologically non homogenic group. Verapamil and diltiazem have myocardial component of their effect, which acts against activated sympathicus. Short acting dihydropyridines (nifedipin) appear to be harmful by patients after myocardial infarction which is caused by the reflex sympathetic response to the predominant vasodilation. In the treatment of cardiovascular disease (e.g. hypertension, coronary vascular disease) are short acting dihydropyridines not recommended. Dihydropyridines of the new generation (amlodipin, felodipin, isradipin, lacidipin, nicardipin, nimodipin, nisoldipin, nitrendipin) induce less tachycardia due to their favorable kinetic features. If the slow movement in blood or at the receptor site is not a result of molecule features there is necessary to use retarded preparations of active substance. Nevertheless, commonly used retarded preparations fulfil this requirement only incompletely. The desirable quality is provided by modern form of retardation. (e.g. GITS) only.

Calcium Channel Blockers↗
PubMed1998

Comparing the use of short-acting and long-acting calcium channel blockers in an HMO.

One of the questions surrounding the controversy over the risks of MI among hypertensives taking calcium channel blockers (CCBs) is the dosage form, and whether the short-acting form may be more likely than the long-acting to increase the risk of MI. This preliminary study compared HMO members receiving the two dosage forms by sociodemographic and clinical characteristics, and by utilization (hospital, office visits, emergency room, outside of HMO services) prior to and during CCB use. The sampling frame was members with one or more dispensings for a CCB 1990 through 1994. Incident users were those who received one or more CCB dispensings and no cardiovascular disease-related drugs the year prior to their first dispensing of a CCB. CCB users were those who had at least 90 days of continuous CCB use. Short-acting outnumbered long-acting users by eight to one. Few incident users of long-acting CCBs were found. Among incident users, diagnoses and comorbidities were similar. In general, short-acting users appeared to have less risk of exposure to heart-related medications, but similar risks of exposure to non-heart-related drugs and to utilization of the various services during the year prior to first use. The odds of being exposed to heart-related medications and non-heart related medications and use of services during periods of use of CCBs were similar in general, but where differences were observed, the odds of being exposed were less among short-acting users. Users of the two dosage forms in this setting prior to reports questioning the safety of short-acting CCBs were different quantitatively and qualitatively making a retrospective comparative study difficult, perhaps not possible, due to substantial selection bias among users. Further patient selection bias has also undoubtedly occurred subsequent to the reports. The final answer to the relative safety and effectiveness of the different dosage forms of calcium channel blockers is likely to have come from randomized clinical trials.

Journal Article↗
PubMed1986

Augmented vasodepressor and sympathetic responses to intracerebroventricular injections of diltiazem, a calcium channel blocker, in DOCA-salt hypertensive rats.

The role of the calcium ion in central cardiovascular regulation was investigated by injecting a calcium channel blocker, diltiazem, intracerebroventricularly (i.c.v.) in urethane-anaesthetized, DOCA-salt hypertensive rats. This produced a fall in blood pressure and bradycardia with corresponding decreases in abdominal sympathetic nerve activity. However, a similar amount of diltiazem injected intravenously (i.v.) did not affect abdominal sympathetic nerve activity despite an accompanying vasodepression. The responses to i.v. injections of diltiazem were not different between the two groups; however, the magnitude of the blood pressure fall, bradycardia and sympathetic inhibition with i.c.v. injections was greater in the DOCA rats than in the sham-operated animals. These results suggest that diltiazem causes the central nervous system to decrease the sympathetic nerve outflow. The augmented central vasodepressor responses to diltiazem in DOCA-salt hypertensive rats may indicate that calcium metabolism in the central nervous system is disrupted and that this is of importance in the pathogenesis of DOCA-salt hypertension in rats.

Animals↗
PubMed1990

Comparison of converting enzyme inhibitor and calcium channel blocker in hypertensive glomerular injury.

The protective effect of converting enzyme inhibitors in experimental hypertensive glomerular injury is associated with decreased systemic arterial and glomerular capillary pressure. Although calcium channel blockers effectively lower systemic blood pressure, their effect on glomerular capillary pressure and on hypertensive glomerular injury is uncertain. We compared equihypotensive treatment with the calcium antagonist TA 3090 or the converting enzyme inhibitor captopril in post-salt hypertensive Dahl salt-sensitive (DS) rats for up to 5 weeks after five sixths nephrectomy. Before the nephrectomy, all rats demonstrated hypertension (mean 177 mm Hg), proteinuria (mean 175 mg/day), and mild glomerulosclerosis (mean injury score 35). Rats treated with captopril or TA 3090 demonstrated a significant and equivalent decrease in systolic blood pressure compared with untreated rats at 2, 3, and 5 weeks after five sixths nephrectomy; however, only captopril reduced proteinuria. Final proteinuria was actually increased in rats treated with TA 3090 compared with untreated rats. Glomerular injury score was significantly decreased in captopril-treated compared with untreated rats at 2 weeks (33 +/- 9 versus 117 +/- 10, p less than 0.05) and 5 weeks (46 +/- 9 versus 94 +/- 24, p less than 0.05), whereas treatment with TA 3090 delayed but did not prevent progressive glomerular injury (2-week score 35 +/- 7, p less than 0.05 versus untreated; 5-week score 109 +/- 19, p = NS versus untreated). Thus, in hypertensive DS rats after subtotal nephrectomy, treatment with a converting enzyme inhibitor reduced systemic blood pressure, proteinuria, and glomerulosclerosis. However, equihypotensive treatment with a calcium channel blocker did not reduce proteinuria and delayed but did not prevent glomerulosclerosis. Thus, in the rat similar reductions in systemic blood pressure with these two classes of agents have disparate effects on the progression of chronic renal failure.

Animals↗
PubMed2004

Dihydropyridine calcium channel blockers: basic pharmacological similarities but fundamental therapeutic differences.

Recent trials indicate that treatment with calcium channel blockers (CCBs) reduces cardiovascular morbidity and mortality in hypertensive patients (including those with significant coronary artery disease). Since the fundamental mechanism of action of all CCBs is the same, it might be assumed that the findings of these outcome studies can be generalized to all types of CCB. However, in the light of the well-recognized clinical pharmacological differences between the 'rate-limiting' agents, verapamil and diltiazem, and the dihydropyridine group of CCBs, this must be considered to be a misconception. Less well-recognized, and often ignored, are the significant differences between agents within the dihydropyridine group. These differences translate to distinct differences in the therapeutic profiles and may well translate into differences in outcome during long-term treatment. Thus, the differences in pharmacokinetic, pharmacodynamic and therapeutic profiles make it clear that caution should be exercised in assuming that all dihydropyridine CCBs licensed for once-daily administration are equivalent in terms of their durations of action and overall antihypertensive efficacy.

Calcium Channel Blockers↗
PubMed2000

Calcium-channel blocker attenuates Kupffer cell production of cytokine-induced neutrophil chemoattractant following ischemia-reperfusion in rat liver.

We investigated the effects of the calcium-channel blocker verapamil hydrochloride on the production of cytokine-induced neutrophil chemoattractant (CINC) following reperfusion injury in rat liver. Ischemia was induced for 30 min by portal vein occlusion. Animals were pretreated with intravenous injection of verapamil hydrochloride (2.5 mg/kg) 5 min before vascular clamp. Verapamil hydrochloride limited increases in the chemoattractant compared with nonpretreated rats. Most cells immunostained for chemoattractant were ED2-positive macrophages in sinusoids. In vitro chemoattractant production by Kupffer cells isolated from animals pretreated with verapamil hydrochloride was significantly lower than by Kupffer cells from nonpretreated animals. Expression of transcripts in liver for chemoattractant peaked 3 hr after reperfusion in nonpretreated animals, while pretreatment with verapamil hydrochloride significantly decreased chemoattractant mRNA levels. In vitro chemoattractant production could be induced in naive Kupffer cells after stimulation with oxygen radicals generated by hypoxanthine and xanthine oxidase, but verapamil hydrochloride prevented these increases. We concluded that the calcium-channel blocker verapamil hydrochloride significantly attenuates chemoattractant release by Kupffer cells after ischemia-reperfusion in the rat liver.

Animals↗
PubMed2003

Effects of first and second generation calcium channel blockers on diastolic function of the failing hamster heart: relationship with coronary flow changes.

Calcium channel blockers (CCBs) have variable efficacy in the treatment of heart failure. We hypothesized that modulation of left ventricular diastolic pressure (LVDP) may play a role in the variable efficacy of CCBs in this condition. Isolated perfused hearts from 200- to 250-day-old UM-X7.1 cardiomyopathic hamsters (failing hearts) and age-matched Syrian hamsters (normal hearts) were studied. After recording of heart rate, coronary flow (CF), LVDP and left ventricular systolic pressure (LVSP), hearts were exposed either to verapamil or diltiazem (1 nM-10 microM), mibefradil (1 nM-1 microM) or clentiazem (1 nM-10 microM). Mechanical increase in CF (+2 to +10 ml/min) was carried out using a roller pump. Mechanically-augmented flow led to an increase in coronary perfusion pressure (+40 to +90 mm Hg), LVSP (+5 to +40 mm Hg) and LVDP (+5 to +25 mm Hg). CCBs-induced increment of coronary flow led to a difference in their cardiac response. In normal hearts, the negative inotropic response was more important with diltiazem and verapamil. Failing hearts did not demonstrate increased inotropic sensitivity to first-generation CCBs. On the contrary, at clinically relevant concentrations, verapamil resulted in the most pronounced impairment of LVDP followed by diltiazem while mibefradil and clentiazem, at clinically relevant concentrations, preserved LVDP. Such findings provide an additional explanation for the variable efficacy of CCBs in heart failure.

Animals↗
PubMedDate not supplied

Prophylaxis of migraine attacks with a calcium-channel blocker: flunarizine versus methysergide.

In this study, flunarizine, a selective calcium-channel blocker, was employed in the prophylactic treatment of headache and was compared with methysergide in terms of efficacy. The trial was conducted with 104 patients (53 treated with flunarizine and 51 treated with methysergide) and lasted six months--one month of pretreatment and five months of therapy. Patients in both groups experienced a highly significant reduction in the number and duration of migraine attacks. Unlike those in the methysergide group, patients treated with flunarizine achieved a significant reduction in the intensity of attacks with very negligible side effects.

Adult↗
PubMed1995

Color Doppler ultrasound analysis of ocular circulation after topical calcium channel blocker.

PURPOSE: To investigate the effect of topical administration of the calcium channel blocker verapamil on intraocular pressure and retrobulbar hemodynamics. METHODS: In this randomized, prospective, double-masked study, we examined the effects of single-dose topical administration of verapamil in ten normal human volunteers by using color Doppler ultrasound imaging to measure hemodynamic parameters. Limitations of this study include single-dose application of verapamil and relatively small sample size. RESULTS: No systemic effect on heart rate or blood pressure was detected after administration of topical verapamil. The intraocular pressure significantly decreased compared with baseline two hours after topical 0.125% and 0.25% verapamil (P = .015 and .040, respectively). Pourcelot's ratio, an index of vascular resistance, measured in the central retinal artery was significantly reduced after topical application of 0.125% verapamil (P = .008). The change in Pourcelot's ratio primarily resulted from an increased end diastolic velocity in the central retinal artery. No significant differences compared with baseline values were detected in the color Doppler ultrasound measurements of the posterior ciliary arteries and the central retinal vein two hours after topically administered verapamil. CONCLUSIONS: Topical administration of verapamil decreases intraocular pressure and alters ocular hemodynamics, reducing the vascular resistance index in the central retinal artery.

Administration, Topical↗