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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Isradipine, a new calcium antagonist, was administered to 51 Pakistani patients with hypertension (36 women, 15 men; mean age 47 years) over an 8-week period. Mean sitting systolic, and sitting and standing diastolic blood pressure was significantly reduced, and mean standing systolic blood pressure tended to decrease. Laboratory values, and both sitting and standing heart rates were not significantly affected by isradipine treatment. At the end of 8 weeks, 41.2% of patients were receiving isradipine 1.25mg twice daily, and 58.8% were receiving 2.5mg twice daily. Isradipine was found to be effective and well tolerated in Pakistani patients with mild to moderate hypertension.
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PMID:Isradipine in Asian patients with hypertension. 215 Jun 36

Hypertension is a major risk factor for coronary heart disease (CHD) and is the primary risk factor for stroke. Drug trials lowering blood pressure by pharmacological means have demonstrated impressive reduction in both fatal and nonfatal stroke (33 to 50%) that are virtually identical to the predicted stroke reduction, considering the observed diastolic blood pressure change (5 to 6mm Hg). On the other hand, reduction of CHD risk has been less impressive in these same trials. Although statistically significant, the reduction in CHD risk is roughly one-half (14%) of that predicted (25%) when results from these drug trials are analysed in aggregate. Most trials have used moderate to high dosages of thiazide diuretics or beta-blockers as therapies. Several factors may account for the disappointing results in CHD risk reduction. These drugs may induce metabolic disturbances in lipids, increased glucose tolerance, insulin resistance, or cause inadequate regression of left ventricular hypertrophy, thus attenuating the predicted reduction in CHD risk associated with pharmacological blood pressure lowering. Isradipine is a new dihydropyridine calcium antagonist that is highly effective in lowering blood pressure. Isradipine also has antiatherogenic properties in animal models of atherosclerosis. The effect of isradipine on atherosclerosis in humans is unknown. The Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS) is a 3-year double-blind, randomised trial in over 800 men and women with hypertension, aged 40 years or older. The primary aim of MIDAS is to compare the efficacy of isradipine 2.5 to 5.0mg twice daily vs hydrochlorothiazide 12.5 to 25mg twice daily in retarding the progression of extracranial carotid atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A comparison of antihypertensive drug effects on the progression of extracranial carotid atherosclerosis. The Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS). 215 Jun 40

The effects of isradipine in a rat model of embolic stroke [permanent occlusion of the left middle cerebral artery (MCA)] are reviewed. Isradipine, when present or given up to 4 hours after the onset of stroke, reduces the infarct size, determined by magnetic resonance imaging (MRI) 24 hours, and by histology 5 days, after MCA occlusion. These cytoprotective effects seem to be permanent and are paralleled by an improvement in the neurological deficit. Isradipine has proved to be the most potent and effective calcium antagonist for reducing the infarct size compared with other representatives of this class of drugs such as nimodipine, nicardipine and flunarizine. Isradipine is cytoprotective after a stroke when used as an antihypertensive: at doses which normalise high blood pressure in spontaneously hypertensive rats, isradipine reduces by more than 60% the infarct size caused by a subsequent stroke. Since the lowering of blood pressure, e.g. by a calcium antagonist that does not cross the blood-brain barrier, is ineffective in reducing the infarct size, normalisation of blood pressure alone cannot account for the reductions in infarct size observed with isradipine. The antihypertensive drug isradipine seems rather to offer the additional benefit of attenuating the consequences of an eventual stroke. If clinically confirmed, this will be of considerable therapeutic importance. Evidence is presented that isradipine has at least 2 mechanisms within the brain that might be responsible for cytoprotection in stroke.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Experimental studies with isradipine in stroke. 215 Jun 41

The calcium antagonists of the dihydropyridine group, isradipine and nifedipine, were compared in 64 patients with mild to moderate hypertension (diastolic blood pressure 95 to 110mm Hg). A 2-week placebo run-in phase was followed by a double-blind crossover trial comprising two 3-week treatment periods with either calcium antagonist. The (fixed) dosages were isradipine 2.5mg twice daily and nifedipine retard 20mg twice daily. Blood pressure (systolic/diastolic) at baseline was 155/101mm Hg and decreased significantly by 14%/15% on isradipine and by 11%/12% on nifedipine (difference between treatments not significant). The drugs differed significantly with regard to incidence of adverse effects (mostly flushing and headache); the total rates were 16% on isradipine and 36% on nifedipine. At the end of the trial, patients were asked which drug or treatment phase they preferred. Isradipine was preferred by 50% of patients; only 20% preferred nifedipine. Thus, it is concluded that isradipine, administered in an equally effective antihypertensive dosage regimen is superior to nifedipine with regard to the incidence of adverse effects, resulting in greater patient satisfaction with treatment.
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PMID:The calcium antagonist isradipine in the therapy of hypertension. A double-blind crossover comparison with nifedipine. 215 Jun 44

Treatment of hypertension may prevent many of the complications attributable to blood pressure elevation, particularly those that are "pressure-related," such as stroke. However, the atherosclerotic complications of hypertension, e.g., coronary artery disease manifested as coronary morbidity and mortality, have not been reduced significantly with antihypertensive therapy. This disappointing outcome may reflect the adverse metabolic effects of the traditional therapies, diuretics and beta blockers, and their lack of specific vasoprotective properties. Increasing attention is thus being paid to the newer antihypertensive agents, which typically have fewer adverse effects and perhaps more physiologic mechanisms of antihypertensive action. Since calcium plays a key role in the genesis of atherosclerosis, calcium antagonists may positively affect the course of vascular disease. Investigators have observed that calcium antagonists display clear antiatherosclerotic properties in experimental as well as clinical studies. In one recently published clinical study, coronary artery disease was shown to develop more slowly, with a slower progression of individual stenoses, higher regression rate and less frequent occurrence of new lesions in patients treated chronically with verapamil compared to those receiving conventional therapies. Other similar investigations are currently under way to evaluate the antiatherogenic properties of calcium antagonists, including the Frankfurt Isoptin Progression Study (FIPS), the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS), the International Nifedipine Trial on Atherosclerosis Coronary Therapy (INTACT), and the large-scale Montreal Heart Institute Study. Results of these studies, which use precise end points such as myocardial infarction, cerebral infarction and peripheral vascular disease, may revolutionize the treatment of hypertension by identifying therapeutic approaches that control both the pressure-related and atherosclerotic complications of the disease.
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PMID:Anti-atherosclerotic and vasculoprotective actions of calcium antagonists. 225 66

Of the calcium channel blocking drugs, only verapamil is approved in the United States for treatment of hypertension. Isradipine is a 1,4-dihydropyridine calcium blocker that may be given on a twice-daily basis. It causes peripheral vasodilation with minimal cardiodepressant activity. We undertook a double-blind, parallel group randomized, multicenter study of 203 hypertensive subjects to examine the efficacy and safety of isradipine in treatment of hypertension. Subjects were given 0, 2.5, 5, 7.5, or 10 mg isradipine twice daily for up to 5 weeks. There was a significant dose-response relationship between isradipine dose and decrease in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Isradipine 15 mg/day reduced supine pressure by 16/15 mm Hg in patients with starting DBP less than 105 mm Hg and by 38/22 mm Hg in those with starting DBP greater than or equal to 105 mm Hg. There was no significant orthostatic fall in blood pressure at any dose. Heart rate (HR) increased on an average by only a maximum of four beats/min. The drug was slightly more effective in the elderly in the standing position than in the young in the standing position. Adverse effects were mild, and only six patients were discontinued from the study because of adverse effects. Isradipine appears to be a safe, effective drug in monotherapy of hypertension at a wide range of patient ages.
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PMID:Efficacy and safety of isradipine in hypertension. 247 Sep 95

One hundred eighteen patients, aged between 65 and 87 years with mild-to-moderate hypertension were given placebo or isradipine (1.25 to 5 mg twice daily, or 2.5 to 10 mg once daily) following a three-week placebo period to evaluate its safety and efficacy in elderly patients. Dosage step-up was at three-week intervals. Blood pressure measurements were taken immediately before the morning dose (12 to 24 hours after the previous dose). At the end of the study, both supine and standing diastolic blood pressures were significantly lower with isradipine than with placebo. A 10-mm Hg reduction in supine diastolic blood pressure was achieved with once-daily isradipine in 65 percent and with twice-daily isradipine in 52 percent of patients, indicating sustained blood pressure control over the dose interval (12 to 24 hours). Adverse events were usually mild, transient, and typical for vasodilators. Isradipine did not produce more laboratory, clinical, or electrocardiographic abnormalities than did placebo. In conclusion, isradipine either once or twice daily at doses between 2.5 and 10 mg is an effective and well-tolerated treatment for mild-to-moderate hypertension in elderly patients.
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PMID:Evaluation of the safety and efficacy of isradipine in elderly patients with essential hypertension. The British Isradipine Hypertension Group. 252 44

Earlier studies have shown isradipine to reduce the size of infarct in a rat model of embolic stroke (permanent occlusion of the left middle cerebral artery) (Sauter A, Rudin M: Stroke 1986; 17: 1228-1234). The greater the delay in isradipine administration after occlusion of the left middle cerebral artery, the less these effects until no effect on infarct size was obtained when isradipine was injected six hours after occlusion of the left middle cerebral artery. Blood pressure was dose-dependently reduced in spontaneously hypertensive rats (blood pressure more than 200 mm Hg), which received injections of isradipine subcutaneously 2.5, 5, and 10 mg/kg per day for six days, to approximately 150, 135, and 120 mm Hg, respectively. Twelve hours post-injection, the left middle cerebral artery was occluded. Isradipine also dose-dependently decreased infarct size, as measured by magnetic resonance imaging at 24 hours and histology five days later, by approximately 20, 40, and 60 percent, respectively, compared with vehicle-injected controls. These results suggest that isradipine, at doses required to normalize the high blood pressure in spontaneously hypertensive rats, will substantially reduce the infarct size caused by a later stroke.
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PMID:Treatment of hypertension with isradipine reduces infarct size following stroke in laboratory animals. 252 48

The hemodynamic response achieved by isradipine is balanced; there is a marked decrease in total peripheral resistance with no clinically significant tachycardia or cardiodepressant effect, no fluid retention (natriuretic/diuretic effect) or orthostatic reactions, whereas the blood flow to vital organs is preserved. The blood pressure-lowering effect of isradipine as monotherapy is dose dependent and has shown a greater efficacy than propranolol, hydrochlorothiazide, and prazosin, without an increase in adverse effects. Combination therapy with a beta-blocker is also safe and offers a useful additional reduction in blood pressure. Indeed, the side effects are no more frequent than with placebo (in doses below 10 mg daily); they are also dose dependent and appear to diminish with time. Isradipine's antiatherogenic effects and cardiac protection potential require further evaluation in clinical studies, but add an interesting aspect to the drug. Against this background, isradipine appears to be a useful addition to our therapeutic arsenal and has the potential to become the drug of choice in the treatment of hypertension.
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PMID:Hemodynamic response, safety, and efficacy of isradipine in the treatment of essential hypertension. 252 51

A dose-finding pilot study including six patients concluded that isradipine at an initial rate of 0.6 microgram/kg/minute, decreasing to 0.3 microgram/kg/minute with further adjustments as necessary, was safe for the treatment of post-aortocoronary bypass graft hypertension. A comparative study followed, comprising 20 patients randomly assigned to receive isradipine (starting at 0.6 microgram/kg/minute) or nitroprusside (initially 1 microgram/kg/minute) for the treatment of post-aortocoronary bypass graft hypertension. Both drugs produced a satisfactory reduction in arterial blood pressure accompanied by a decrease in systemic vascular resistance. Central venous pressure and mean pulmonary artery pressure decreased with nitroprusside, but both increased with isradipine. Pulmonary capillary wedge pressure was reduced, heart rate increased, and cardiac output was minimally changed with nitroprusside. However, wedge pressure was maintained with isradipine and there was no tachycardia. An increase in cardiac output was seen, associated with an increase in stroke index. Isradipine is a more specific treatment for post-aortocoronary bypass graft hypertension than nitroprusside because its systemic arterial dilating effect is associated with a minimum of other circulatory changes.
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PMID:Use of isradipine in hypertension following coronary artery bypass surgery. 252 61


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