The Effects of Age and Race on Nitrendipine Pharmacokinetics and Pharmacodynamics

Lettieri, John; Krol, G.J.; Yeh, S. C.; Burkholder, Dana; Zinny, Miguel A.; O'Donnell, D M

doi:10.1097/00005344-198806124-00028

Cited by 11 publications

(2 citation statements)

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“…Nifedipine clearance is reported to be lower in persons of African ancestry, with a 150% greater area under the plasma concentration-time curve; and a 79% higher elimination half-life [46], but no significant differences were found for nitrendipine [58]. …”

Section: Resultsmentioning

confidence: 99%

Why do hypertensive patients of African ancestry respond better to calciumblockers and diuretics than to ACE inhibitors and β-adrenergic blockers? Asystematic review

Brewster

Seedat

2013

BMC Med

117

134

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BackgroundClinicians are encouraged to take an individualized approach when treating hypertension in patients of African ancestry, but little is known about why the individual patient may respond well to calcium blockers and diuretics, but generally has an attenuated response to drugs inhibiting the renin-angiotensin system and to β-adrenergic blockers. Therefore, we systematically reviewed the factors associated with the differential drug response of patients of African ancestry to antihypertensive drug therapy.MethodsUsing the methodology of the systematic reviews narrative synthesis approach, we sought for published or unpublished studies that could explain the differential clinical efficacy of antihypertensive drugs in patients of African ancestry. PUBMED, EMBASE, LILACS, African Index Medicus and the Food and Drug Administration and European Medicines Agency databases were searched without language restriction from their inception through June 2012.ResultsWe retrieved 3,763 papers, and included 72 reports that mainly considered the 4 major classes of antihypertensive drugs, calcium blockers, diuretics, drugs that interfere with the renin-angiotensin system and β-adrenergic blockers. Pharmacokinetics, plasma renin and genetic polymorphisms did not well predict the response of patients of African ancestry to antihypertensive drugs. An emerging view that low nitric oxide and high creatine kinase may explain individual responses to antihypertensive drugs unites previous observations, but currently clinical data are very limited.ConclusionAvailable data are inconclusive regarding why patients of African ancestry display the typical response to antihypertensive drugs. In lieu of biochemical or pharmacogenomic parameters, self-defined African ancestry seems the best available predictor of individual responses to antihypertensive drugs.

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Section: Resultsmentioning

confidence: 99%

Why do hypertensive patients of African ancestry respond better to calciumblockers and diuretics than to ACE inhibitors and β-adrenergic blockers? Asystematic review

Brewster

Seedat

2013

BMC Med

117

134

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“…Old age has been associated with further increases in the AVC, Cmax and t'l2 (to about 50 hours) of amlodipine and with reduced CL (Abernethy et al 1990;Elliott et al 1988). Plasma concentrations of felodipine (Blychert et al 1991;Landahl et al 1988), nisoldipine (Baksi et al 1991), isradipine (Schran et al 1988), nicardipine (Forette et al 1985) and nitrendipine (Lettieri et al 1988) are all higher in elderly people than in younger adults. Systemic availability of lacidipine is increased in healthy elderly people (Hall et al 1991).…”

Section: L2 Individual Agentsmentioning

confidence: 97%

Calcium Antagonists in the Elderly

Kelly¹,

O’Malley

1993

Drugs & Aging

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The calcium antagonists are associated with a number of advantages over other antihypertensive agents, such as a lack of metabolic, vascular and respiratory adverse events, yet are effective in reducing blood pressure. The currently available calcium antagonists are widely used, and new members, particularly of the dihydropyridine group, continue to emerge. These agents may well be considered for use in the management of hypertension and angina in elderly people. They undergo significant first-pass metabolism and tend to have high values of hepatic clearance with minimal amounts of unchanged drug in the urine. Plasma concentrations tend to be higher in elderly people and for that reason it may be prudent to initiate therapy with lower dosages. With this caveat, adverse effect profiles seem to be qualitatively and quantitatively similar in younger and older people. At equivalent plasma concentrations, the antihypertensive effect appears similar in young and elderly patients, and clinical studies point to comparable efficacy with other drug classes. Calcium antagonists do not have adverse renal, respiratory, cardiovascular, metabolic or peripheral vascular effects and therefore may be useful in patients with relevant concomitant disease.

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Primary Prevention of Cardiovascular Events in Older Individuals

Patterson

Grymonpre

2004

Developments in Cardiovascular Medicine

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The Effects of Age and Race on Nitrendipine Pharmacokinetics and Pharmacodynamics

Cited by 11 publications

References 0 publications

Why do hypertensive patients of African ancestry respond better to calciumblockers and diuretics than to ACE inhibitors and β-adrenergic blockers? Asystematic review

Why do hypertensive patients of African ancestry respond better to calciumblockers and diuretics than to ACE inhibitors and β-adrenergic blockers? Asystematic review

Calcium Antagonists in the Elderly

Primary Prevention of Cardiovascular Events in Older Individuals

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