Hemodynamic Effects of Calcium Channel Blockers in Essential Hypertension

Purpose We aimed to examine the changes in choroidal blood flow (CBF), choroidal pulse waveform, and central choroidal thickness (CCT) in a case of pregnancy-induced hypertension (PIH) using laser speckle flowgraphy (LSFG) and enhanced depth imaging optical coherence tomography (EDI-OCT) before and after treatment with antihypertensive drugs. Observations A 24-year-old Japanese woman diagnosed with PIH presented with complaints of worsening and blurred vision in the right eye. Funduscopic findings at the initial visit showed serous retinal detachment (SRD), retinal hemorrhage, and arterial tortuosity. The LSFG color map showed a warm color. Macular mean blur rate (MBR), which is an index of relative blood flow velocity, in both eyes was high, along with choroidal thickening. Blowout time (BOT), which indicates the rate of time in which the MBR is greater than half the amplitude during one heartbeat, was low and acceleration time index (ATI), which represents the time-to-peak of MBR, was high. Several weeks after treatment with antihypertensive drugs, the CBF and ATI gradually decreased with regression of the SRD and thinning of the CCT. On the other hand, BOT gradually increased after treatment, showing a significant decrease in vascular resistance. Ocular perfusion pressure decreased after treatment because of the reduction in blood pressure. Conclusions and Importance LSFG might reveal choroidal overperfusion and increased vascular resistance, along with SRD and choroidal thickening, in a patient with PIH with reversal after treatment with antihypertensive drugs. These findings demonstrate the importance of evaluation of ocular blood flow and vascular resistance in women with PIH in order to routinely assess the clinical and systemic condition.

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“…Hydralazine and calcium channel blockers have been reported to play an essential role in direct vasodilation of the arterioles. 24 , 25 …”

Section: Discussionmentioning

confidence: 99%

Changes in choroidal circulation and pulse waveform in a case of pregnancy-induced hypertension with serous retinal detachment

Yata

Hashimoto

Masahara

et al. 2020

American Journal of Ophthalmology Case Reports

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Use of invasive ergometric exercise to assess the hemodynamic response to nicardipine

Cody

1987

The American Journal of Cardiology

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Systemic and pulmonary hemodynamic responses to nicardipine during graded ergometric exercise in patients with moderate to severe essential hypertension

Cody¹,

Kubo²,

Ryman³

et al. 1987

Journal of the American College of Cardiology

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In 10 patients with moderate to severe hypertension, the hemodynamic effects of ergometric exercise and nicardipine, a dihydropyridine calcium channel antagonist, were characterized under basal conditions and after 1 week of therapy. The responses of plasma renin activity and catecholamines were also assessed. Nicardipine induced significant reductions of systolic, diastolic and mean blood pressure under conditions of rest and peak exercise (p less than 0.001), mediated by reversal of vasoconstriction (p less than 0.001). Overall, cardiac index and stroke volume index responses were not significantly altered by nicardipine. Although rest pulmonary wedge pressure was unchanged (6 +/- 3 to 5 +/- 4 mm Hg), peak exercise pulmonary wedge pressure decreased from 24 +/- 22 to 7 +/- 5 mm Hg (p less than 0.001) with nicardipine therapy. This effect of nicardipine on pulmonary wedge pressure was present across all work loads studied, and was accompanied by reduction of peak exercise pulmonary artery pressure from 43 +/- 10 to 25 +/- 7 mm Hg (p less than 0.001). Oxygen consumption was unchanged, associated with reduction of arteriovenous oxygen difference (p less than 0.02). Both plasma renin activity (p less than 0.05) and norepinephrine (p less than 0.005) were significantly increased with nicardipine therapy. Thus, nicardipine produced significant blood pressure reduction by reversal of vasoconstriction in patients with essential hypertension. The preservation of cardiac output, with markedly reduced pulmonary wedge pressure, indicated that nicardipine improved ventricular performance in response to reversal of vasoconstriction.

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Hemodynamic Effects of Calcium Channel Blockers in Essential Hypertension

Cited by 3 publications

References 32 publications

Changes in choroidal circulation and pulse waveform in a case of pregnancy-induced hypertension with serous retinal detachment

Changes in choroidal circulation and pulse waveform in a case of pregnancy-induced hypertension with serous retinal detachment

Use of invasive ergometric exercise to assess the hemodynamic response to nicardipine

Systemic and pulmonary hemodynamic responses to nicardipine during graded ergometric exercise in patients with moderate to severe essential hypertension

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