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

The anti-hypertensive activity and influence on some forms of stress of slow-release Nicardipoine and Captopril were compared using a randomized 2:1 protocol. Thirty-six patients, mean age 55.9 years, suffering from slight or moderate arterial hypertension were treated with either 40 mg of Nicardipine retard twice a day (b.i.d.), or Captopril in a dose of 25 mg (b.i.d.) for 8 weeks. A significant reduction was observed in arterial pressure, both in orthostatism and clinostatism, following both treatments in comparison to the placebo period, but the group treated with slow-release Nicardipine showed a greater and statistically significant reduction in arterial pressure. No significant change in heart rate was reported using either drug. Non-invasive out-patient monitoring of arterial pressure, performed using Spacelabs 5300, showed a significant reduction in arterial pressure using both drugs and the conservation of the normal circadian rhythm of arterial pressure. The pressure response to the cold pressor test (CPT), mental arithmetic test (MAS), and to dynamic and isometric effort was positive with both drugs, thus revealing a degree of protection offered by treatment using these two substances. In overall terms, the two drugs were well tolerated.
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PMID:[Slow-release nicardipine in the treatment of arterial hypertension: comparative study vs. an ACE inhibitor]. 830 42

Slow calcium channel antagonists are widely used among transplanted patients suffering from hypertension, although some of them tend to reduce hepatic blood flow. The aim of our study was to determine the pharmacological properties of nicardipine in transplanted patients with hypertension. Ten hours after liver transplantation, six patients (three men, three women) received 5 mg of intravenous nicardipine to prevent high blood pressure during intensive care. Prior to the administration and during the study (at the completion of the infusion, 3, 5, 10, 15, 20, 30, 45, and 60 min after infusion), the systemic and splanchnic parameters were measured (Swan Ganz catheter). Blood samples were drawn simultaneously from radial artery and free hepatic veins, in order to obtain the hepatic extraction of nicardipine. The hepatic extraction ratio was around 70% for the first 3 min, then decreased and remained stable thereafter, around 45%, showing a non linear first-pass metabolism pattern. Plasma hepatic clearance of nicardipine (699-850 ml/min) was close to total plasma clearance throughout the study (978 +/- 222 ml/min, from 71 to 87%) and half of the estimated hepatic plasma flow values at the same times (1467-1770 ml/min, from 44 to 51%). No statistically significant changes were observed in cardiac output and hepatic blood flow during the study, although there was a decrease in mean arterial blood pressure from 87 +/- 6 mmHg baseline level to 76 +/- 3 mmHg, 60 min after administration. Nicardipine chlorhydrate seems to be appropriate in post operative liver transplant patients when blood pressure must be decreased. Nicardipine safely lowers peripheral resistance, and does not induce changes in hepatic blood flow.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical pharmacology of nicardipine in liver transplant patients. 831 98

Seven patients scheduled for clipping of an aneurysm of the internal carotid artery after subarachnoid haemorrhage, were studied in order to evaluate the efficacy of a bolus injection of nicardipine (2 mg) in the treatment of intra-operative hypertension on the blood flow velocity of vessel near the aneurysm under isoflurane anaesthesia. The blood flow velocity of the vessel near the aneurysm was measured using a 20 MHz ultrasound Doppler flowmeter. Nicardipine bolus significantly decreased the mean arterial blood pressure by about 30% (P < 0.01). The blood flow velocity of the internal carotid artery increased after the nicardipine bolus (from 43.3 +/- 9.9 to 51.7 +/- 15.0 cm s-1) (P < 0.05) but returned to the pre-injection level within 30 min (43.9 +/- 10.4 cm s-1). Nicardipine proved effective for control of intra-operative hypertension during aneurysm clipping.
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PMID:Effect of nicardipine on the blood flow velocity in the vessel near a cerebral aneurysm of the internal carotid artery during cerebral aneurysm surgery: its therapeutic use for intra-operative hypertension. 833 May 98

The concept of Zadeh's fuzzy logistic controller was applied to control hypertension during anesthesia, and its clinical usefulness was examined in patients undergoing elective surgery. Arterial blood pressure was determined by use of an automatic blood pressure device. Nicardipine was used as hypotensive drug. Based on the fuzzy control rules, we developed state-action diagram so as to maintain systolic blood pressure at around 130 mmHg. Nicardipine was infused by using a digitally controlled infusion pump, and its infusion rate was changed according to this diagram. Although acute hypertension associated with endotracheal intubation was not significantly attenuated, hypertension associated with either skin incision or endotracheal extubation, where blood pressure increased slowly, was successfully controlled with our system. These results suggest that the application of the concept of fuzzy logistic controller is useful for treatment of hypertension during anesthesia, especially when blood pressure increases slowly.
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PMID:[Application of the concept of fuzzy logistic controller for treatment of hypertension during anesthesia]. 843 49

Nicardipine is a second generation dihydropyridine calcium antagonist which selectively inhibits vascular smooth muscle contraction. In elderly patients, the drug has demonstrated clinical efficacy in the management of hypertension, angina pectoris and ischaemia-related cerebrovascular disease. In particular, nicardipine effectively controls blood pressure in elderly hypertensive patients with or without coexistent disease. In noncomparative trials, a regimen containing nicardipine has been associated with an improvement of symptoms in hypertensive patients with concurrent coronary artery, cerebrovascular or peripheral vascular disease, while in essentially 'healthy' elderly hypertensive patients, nicardipine monotherapy has resulted in improved indices of mobility and cognitive function. As yet, however, there is no evidence that nicardipine (and/or other calcium channel antagonists) decreases cardiovascular morbidity and mortality in elderly patients, as has been demonstrated for more established antihypertensive therapies, namely diuretics and/or beta-blockers. The pharmacokinetic properties of nicardipine in elderly hypertensive patients appear to be similar to those in younger patients. The main adverse events associated with nicardipine in the elderly are related to the vasodilator properties of the drug and include pedal oedema, headache and flushing. However, the drug does not exacerbate spontaneous postural hypotension in the elderly, nor does it adversely affect the coronary artery disease risk profile, even in patients with type II diabetes mellitus. In summary, widespread clinical experience in the elderly indicates that nicardipine monotherapy or a regimen containing nicardipine is useful for the treatment of hypertension, particularly in patients with coexistent coronary artery, cerebrovascular or peripheral vascular disease. Nicardipine monotherapy has also demonstrated efficacy in angina pectoris and shown promise in the management of ischaemia-related cerebrovascular diseases, notably subarachnoid haemorrhage.
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PMID:Nicardipine. A review of its pharmacology and therapeutic efficacy in older patients. 847 49

This study evaluated the effect of nicardipine, calcium channel blocker, monotherapy on blood pressure and metabolic changes. Various aspect of carbohydrate and lipoprotein metabolism were studied before and after 12 weeks of nicardipine treatment in 23 patients with mild to moderate essential hypertension. Nicardipine was well tolerated and induced a significant decrease (p < 0.001) in both systolic and diastolic blood pressure without any changes in heart rate. Plasma levels of fasting glucose, insulin, C-peptide and hemoglobin A1c, hepatic extraction of insulin were similar following nicardipine treatment. Plasma glucose and insulin responses to an oral glucose challenge did not change in association with nicardipine therapy. Although high density lipoprotein (HDL) cholesterol concentration increased slightly, it did not reach statistical significance. Total cholesterol and low density lipoprotein (LDL) cholesterol levels also increased insignificantly. LDL triglyceride and very low density lipoprotein (VLDL) triglyceride concentrations were higher marginally, which resulted in slightly but insignificantly increase in total triglyceride concentration in association with nicardipine monotherapy for 12 weeks. In conclusion, treatment of patients with mild to moderate hypertension with nicardipine led to lower blood pressure effectively while had no significant influence on carbohydrate and lipoprotein metabolism.
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PMID:Effect of nicardipine treatment on carbohydrate and lipoprotein metabolism in patients with hypertension. 849 May 96

Hypertensive emergency is a condition in which there is elevation of both systolic and diastolic blood pressure with the presence of acute target organ disease. Hypertensive urgency is a condition where the blood pressure is elevated (diastolic > 120 mmHg) with the absence of acute target organ disease. Hypertensive emergencies are best managed with parenteral drugs and careful intraarterial blood pressure monitoring. Hydralazine has been widely used in treatment of hypertension in eclampsia and preeclampsia, and its safety has been demonstrated in these patients. Sodium nitroprusside (SNP) has the most reliable antihypertensive activity, which begins immediately after its administration and ends when the infusion is stopped. As with diazoxide, it should be used with caution in patients with impaired cerebral flow. SNP is the preferred drug in obtaining controlled hypotension in patients undergoing neurovascular surgery. Intravenous nitroglycerin is useful in patients prone to myocardial ischemia, but should be avoided in patients with increased intracranial pressure. Esmolol is effective in controlling both supraventricular tachyarrhythmias and severe hypertension. Its short onset of duration of action make it useful in the emergent setting, but because of its negative inotropic effect its use should be avoided in patients with low cardiac output. Verapamil should not be used in patients with preexisting conduction abnormalities. Nicardipine is a potent arteriolar vasodilator without a significant direct depressant effect on myocardium. As with other afterload reducing agents, it should not be used in patients with severe aortic stenosis. Because angiotensin-converting enzyme (ACE) inhibitors generally cause cerebral vasodilatation, enalaprilat may be particularly beneficial for patients who are at high risk of developing cerebral hypotensive episodes secondary to impaired cerebral circulation. Fenoldopam, a selective post-synaptic dopaminergic receptor (DA1) has been shown to be effective in treating severe hypertension with a lower incidence of side effects than SNP. Hypertensive urgencies can usually be managed with oral agents. Oral nifedipine, captopril, clonidine, labetalol, prazosin, and nimodipine have all been shown to be effective in these situations.
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PMID:Management of hypertensive urgencies and emergencies. 852 30

This trial was designed to confirm the hypotensive action and safety of slow-release nicardipine, as a single drug or together with other hypotensive drugs, for the short-term treatment of mild-to-moderate hypertension, on a large case list of patients in 57 centers throughout Italy. A total of 1011 patients (502 M, 509 F) were admitted, mean age 58.6 +/- 9.1 years (range 25-87), mean weight 72.7 +/- 11.1 kg (range 43-128), with essential (972 cases) or secondary hypertension (39 cases). Nicardipine was given orally at a mean daily dosage of 80 mg (range 40-120), for four weeks. Clinically and statistically significant reductions in systolic and diastolic BP were observed at the end of treatment, with no noteworthy changes in heart rate. Nicardipine single-drug therapy restored normal blood pressure in 79.7% of patients with essential hypertension, and in 72.0% of those with secondary hypertension; nicardipine associated with other hypotensive agents achieved normal blood pressure in respectively 65.9% and 42.9%. Blood pressure returned to normal in 77.3% of patients with essential hypertension aged 65 years or under, and in 66.9% of those over 65 years old. These figures were respectively 70.8% and 46.7% for patients with secondary hypertension. The treatment was very well tolerated by 86.2% of patients; 140 (13.8%) presented adverse reactions, requiring dose reductions in 12, and discontinuation of treatment only in 24 cases. Five patients taking nicardipine together with another drug presented adverse reactions. These results confirm that slow-release nicardipine is effective and extremely well tolerated in the treatment of mild-to-moderate essential or secondary hypertension, in adults and the elderly.
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PMID:[Nationwide drug surveillance project on slow-release nicardipine in the short-term therapy of light/moderate arterial hypertension]. 855 69

Arterial hypertension is frequent in liver transplant recipients on cyclosporine A (CsA). Nicardipine is a calcium channel blocker (CCB) that has been shown to be efficient in controlling postoperative hypertension. However, its use has been limited in organ recipients because of its reported interaction with CsA metabolism. In this report, we studied the results of the long-term use of nicardipine after liver transplantation. Forty-nine consecutive liver transplant recipients with a follow-up longer than 2 years were studied. Immunosuppressive regimen was based on CsA and prednisone. Patients with immediate postoperative hypertension received intravenous nicardipine, secondarily switched to oral nicardipine (group 1, n = 27). Patients with delayed hypertension (i.e., >2 weeks posttransplant) received other antihypertensive drugs which did not interact with CsA metabolism. These patients and those without hypertension formed group 2 (n = 22). The two groups were similar for age, sex, body weight, and transplantation indications. Interaction of nicardipine with CsA metabolism was confirmed. Whereas cyclosporine blood levels were similar in both groups at any time during the study, the mean cyclosporine daily dose required to achieve such levels was 30% lower in group 1 compared with group 2 (P < .01). This resulted in a significant cost-containment. The use of nicardipine was not associated with an increased incidence of graft rejection or CsA toxicity episodes. The results in liver transplant recipients showed that nicardipine interacts with CsA metabolism, leading to a 30% reduction in CsA dose and does not increase the risk of CsA toxicity or graft rejection. Nicardipine can be used safely for the treatment of arterial hypertension after liver transplantation with a potential cost-containment.
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PMID:Nicardipine as antihypertensive therapy in liver transplant recipients: results of long-term use. 902 59

1. The pharmacological profile and the microanatomical localization of Ca2+ channels of the L-type were analysed in sections of the kidney of Wistar-Kyoto (WKY) rats and of spontaneously hypertensive rats (SHR) of different ages. 2. [3H]-Nicardipine was used as a ligand. It was bound to sections of rat kidney in a manner consistent with the labelling of Ca2+ channels of the L-type. The density of [3H]-nicardipine binding sites was similar in WKY rats of different ages and in SHR of 2 and 4 months, but was significantly increased in SHR of 6 months. 3. Light microscope autoradiography revealed the highest density of binding sites in the tubular portion of the nephron and to a lesser extent within smooth muscle of renal arteries and renal corpuscles. In SHR of 4 and 6 months the density of [3H]-nicardipine binding sites was increased within the epithelium of proximal tubules and of the loop of Henle and decreased in renal corpuscles in comparison with WKY rats or 2 month old SHR. 4. These results show that the density of Ca2+ channels of the L-type increases with the worsening of hypertension in SHR. The observation of a different sensitivity to hypertension of Ca2+ channels located in the various portions of the nephron indicates the usefulness of light microscope autoradiography for assessing hypertension-related changes of Ca2+ channels in the kidney.
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PMID:Pharmacological characterization and autoradiographic localization of dihydropyridine-type calcium channels in the kidney of spontaneously hypertensive rats. 907 70


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