How to Improve Effectiveness and Adherence to Antihypertensive Drug Therapy: Central Role of Dihydropyridinic Calcium Channel Blockers in Hypertension

Abstract

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 guidelines support a substantial equivalence amongst various antihypertensive drug classes. However, several studies have also reported clinically relevant differences among antihypertensive drugs, in terms of both BP lowering efficacy and tolerability/safety profile. These differences should be taken into account not only when adopting first-line antihypertensive therapy, but also when titrating or modulating combination therapies, with the aim of achieving effective and sustained BP control. This review will briefly describe evidence supporting the use of dihydropyridinic calcium channel blockers for the clinical management of hypertension, with a particular focus on barnidipine. Indeed, this drug has been demonstrated to be effective, safe and well tolerated in lowering BP levels and in reducing hypertension-related organ damage, thus showing a potential key role for improving the clinical management of hypertension.

Effect of Different Blood-Pressure-Lowering Regimens on the Blood Pressure Control among Hypertensive Patients Treated in Hospital Conditions

“…Tritherapy induced a significant mean reduction of inpatients`s SBP compared with bitherapy. These results are corroborated in other research papers [ 11 , 20 – 22 ]. In the study by Potchoo et al [ 11 ], 39.13% of the hospitalized hypertensive patients received bitherapy, 33.33% tritherapy, 20.29% quadritherapy, and 7.25% monotherapy.…”

“…The combinations including at least one diuretic induced a significant reduction of inpatients' SBP. Multiple clinical and observational studies have also reported clinically relevant differences among antihypertensive drugs, in terms of both BP lowering efficacy and tolerability/safety profile [ 22 ]. These differences should be taken into account not only when adopting first-line antihypertensive therapy but also when titrating or modulating combination therapies, with the aim of achieving effective and sustained BP control.…”

Identification of compounds that rescue otic and myelination defects in the zebrafish adgrg6 (gpr126) mutant

“…Groups with five or more compounds included the pyridines (cluster 1, Figures 4D and 5B) and the tetranortriterpenoids (gedunin derivatives) (cluster 2, Figures 4D and 5B). The pyridine cluster included one pyrazolopyridine and six dihydropyridines, a class of L-type calcium channel blockers with vasodilatory properties (reviewed in Tocci et al, 2018). The gedunins are a family of naturally occurring compounds, previously attributed with antineoplastic and neuroprotective effects (Jang et al, 2010; Subramani et al, 2017).…”

Oxidative Regulation of Vascular Cav1.2 Channels Triggers Vascular Dysfunction in Hypertension-Related Disorders

“…Evidently, Ca 2+ influx through Ca v 1.2 is fundamental to vasoconstriction and myogenic tone of small arteries and arterioles. Antihypertensive drugs including Ca v 1.2 blockers have been successfully used to the management of hypertension-related disorders [ 495 , 496 , 497 , 498 ]. Oxidative stress is a hallmark of hypertension-related disorders.…”