Ann Pharmacother. 2005 Feb 22; [Epub ahead of
print]
Anasarca Edema with Amlodipine Treatment (April).
Sener D, Halil M, Yavuz BB, Cankurtaran M, Ariogul S.
Medical Faculty, Department of Internal Medicine, Hacettepe University,
Ankara, Turkey.
OBJECTIVE: To report a case of anasarca edema associated with
amlodipine use. CASE SUMMARY: A 77-year-old woman with essential
hypertension who had not been treated with any other drug was
prescribed amlodipine 10 mg/day to control her blood pressure.
She developed anasarca edema soon after amlodipine treatment was
initiated. Laboratory test results for possible etiologies were
negative. Discontinuation of amlodipine resulted in dramatic improvement.
DISCUSSION: To our knowledge, as of February 3, 2005, there have
been no other reports of amlodipine-related anasarca edema in
the English literature, and only one case was described in the
Japanese literature. Pretibial edema is the most common adverse
effect of amlodipine. Periocular and perioral edema have occurred
less frequently, but anasarca edema has not emerged as a problem.
An objective causality assessment revealed amlodipine to be a
probable cause of anasarca edema. CONCLUSIONS: In rare instances,
amlodipine may cause generalized edema, which will resolve upon
discontinuation of the drug.
Expert Opin Pharmacother. 2004 Feb;5(2):459-68.
Amlodipine and atorvastatin in atherosclerosis: a review of the
potential of combination therapy.
Jukema JW, van der Hoorn JW.
Department of Cardiology, Leiden University Medical Center, Leiden,
The Netherlands.
Hypertension and hyperlipidaemia are major risk factors for the
development of atherosclerosis. Calcium channel blockers (CCBs)
have been used for decades and have established antihypertensive
effects. Statins have been extensively used because of their potent
lipid lowering properties. Amongst other factors, inflammation
and oxidation are involved in enhanced progression of atherosclerosis
and new lesion development. Therefore, research has been initiated
focusing on the antioxidant and anti-inflammatory properties of
CCBs and statins, beyond their primary effect, in order to evaluate
the possible additive effects of combined treatment of CCBs with
statins as antiatherosclerotic therapy. Clinical studies (e.g.,
the International Nifedipine Trial on Antiatherosclerotic Therapy
[INTACT]) have demonstrated that the antiatherosclerotic action
of CCBs is limited to the attenuation of the first stage of atherosclerogenesis
(fatty streak formation or new lesion growth). The lesions that
pre-existed at the start of CCB therapy did not demonstrate progression
or regression on angiography. However, because the mechanisms
of action of lipid-lowering drugs and CCBs, and their role in
preventing the progression of atherosclerosis differ, it is conceivable
to conclude that these two classes may have an additive or synergic
effect, not only on new lesion formation but also on inhibiting
the progression of established coronary atherosclerosis. Indeed,
this combined effect of lipid-lowering therapy and CCBs on human
coronary atherosclerosis has been reported in the Regression Growth
Evaluation Statin Study (REGRESS) trial. This beneficial effect
of combining CCBs with statins has now been replicated in transgenic
atherosclerotic mice, where the combination of amlodipine and
atorvastatin produced an additional 60% reduction of atherosclerosis
compared with that observed with the statin alone. Serum markers
of atherosclerosis and vascular integrity also improved most in
the combination group. Synergistic effects of the combination
of atorvastatin and amlodipine on acute nitric oxide release/endothelial
function, and additive effects of the combination of amlodipine
and atorvastatin in the improvement of arterial compliance in
hypertensive hyperlipidaemic patients has been demonstrated. Collectively,
these studies support the clinical antiatherosclerotic advantages
of combination of CCBs and statins and in particular, of atorvastatin
with amlodipine beyond their established antihyperlipidaemic and
antihypertensive modes of action.
Adv Perit Dial. 2003;19:10-4.
Effects of antihypertensive drugs on peritoneal vessels in hypertensive
dogs with mild renal insufficiency.
Ishida Y, Tomori K, Nakamoto H, Imai H, Suzuki H.
Department of Nephrology, Saitama Medical School, Saitama, Japan.
The transport capacity of any membrane depends on its surface
area and permeability. In addition, peritoneal capillaries are
probably barriers to solute transport. Although no decisive use
of antihypertensive drugs has been reported in continuous ambulatory
peritoneal dialysis (CAPD) patients with hypertension, those drugs
are known to have various effects on vessels. In the present study,
we used a charge-coupled-device (CCD) camera in renovascular hypertensive
dogs with mild renal insufficiency to investigate the effects
of various antihypertensive drugs on the peritoneal capillaries.
Renovascular hypertension was induced in the dogs by placing silver
clips on both renal arteries to create 90% occlusion. After confirmation
of elevation of blood pressure (usually 20 days after the operation),
each dog's abdomen was opened while the animal was under general
anesthesia. Using a CCD camera, the diameters of the small arteries
of the peritoneum were measured after 3 days' oral administration
of a placebo (n = 5); or of 8 mg CS866, a selective angiotensin
II type 1 receptor blocker (n = 5); or of 10 mg benazepril, an
angiotensin-converting enzyme inhibitor (n = 5); or of 10 mg amlodipine,
a calcium antagonist (n = 5). In dogs receiving CS866, blood pressure
decreased to 128 +/- 6 mmHg from 160 +/- 6 mmHg (p < 0.01).
A similar decrease in blood pressure was observed with the use
of the other drugs. The diameter of the small vessels increased
by 28% +/- 6% in dogs receiving CS866 and by 24% +/- 5% in dogs
receiving benazepril, as compared with 3% +/- 3% in dogs receiving
the calcium antagonist. These data clearly demonstrate that blockade
of the renin-angiotensin system produces an increase in solute
clearance in hypertensive dogs with mild renal insufficiency and
that such blockade may be applicable as therapy for hypertensive
patients on CAPD.
Clin Ther. 2003 May;25(5):1469-89.
Comparison of the blood pressure-lowering effects and tolerability
of Losartan- and Amlodipine-based regimens in patients with isolated
systolic hypertension.
Volpe M, Junren Z, Maxwell T, Rodriguez A, Gamboa R, Gomez-Fernandez
P, Ortega-Gonzalez G, Matadamas N, Rodriguez F, Dass B, Kyle C,
Clarysse L, Bryce A, Moreno-Heredia E, Germano G, Gilles L, Smith
RD, Sanderson JE; CDSP-944 Study Group.
Universita degli Studi di Roma "La Sapienza", Rome,
Italy.
BACKGROUND: Elevated systolic blood pressure is a more important
risk factor for cardiovascular and renal disease than elevated
diastolic blood pressure. Isolated systolic hypertension (ISH)
is the predominant form of hypertension in the elderly. Effects
of angiotensin II on the vascular wall and endothelium may contribute
to development of ISH. OBJECTIVE: The primary objective of this
study was to compare the effects on trough sitting systolic blood
pressure (SiSBP) of a regimen of losartan, a selective angiotensin
II-receptor antagonist, and an amlodipine-based regimen in patients
with ISH. METHODS: This multicenter, prospective, randomized,
double-blind, parallel-group study consisted of a 4-week placebo
phase and an 18-week active-treatment phase. The losartan-based
regimen consisted of losartan 50 mg, increased as needed to losartan
50 mg/hydrochlorothiazide (HCTZ) 12.5 mg at week 6 and to losartan
100 mg/HCTZ 25 mg at week 12 to achieve a target SiSBP <140
mm Hg. the amlodipine-based regimen consisted of amlodipine 5
mg, increased as needed to amlodipine 10 mg at week 6 and to amlodipine
10 mg/HCTZ 25 mg at week 12. The primary efficacy measure was
change in trough SiSBP from baseline to week 18. Information on
the tolerability of study treatments was collected at each visit,
including the investigator's and patient's observations of clinical
adverse experiences (CAEs), laboratory adverse experiences, and
responses to a symptom questionnaire. RESULTS: Eight hundred fifty-seven
patients (65.6% female) were randomized to treatment, 432 in the
losartan group and 425 in the amlodipine group. Their mean age
was 67.6 years, and they had a mean duration of hypertension of
6.7 years at baseline. The losartan and amlodipine groups (intent-to-treat
population) had baseline mean SiSBP values of 171.2 and 171.9
mm Hg, respectively. At week 18 (the primary end point), the mean
change from baseline in SiSBP was -27.4 mm Hg for 426 patients
who received losartan and -28.1 mm Hg for 419 patients who received
amlodipine (estimated least-square mean difference, 0.3 mm Hg;
95% CI, -1.4 to 2.0), indicating that losartan's effect on systolic
blood pressure was noninferior to that of amlodipine. The proportion
of patients who responded (SiSBP <140 mm Hg or a > or =20-mm
Hg decrease in SiSBP from baseline) was comparable between groups
(73.9% losartan, 75.4% amlodipine). The incidence of CAEs and
drug-related CAEs was significantly greater in the amlodipine
group (amlodipine, 79.8% and 43.8%, respectively; losartan, 67.8%
and 25.5%; P < or = 0.001). In addition, more patients in the
amlodipine group discontinued therapy due to a drug-related CAE
compared with patients in the losartan group (12.9% vs 4.4%, respectively;
P < or = 0.001). Lower-extremity edema was the most common
drug-related CAE in the amlodipine group (24.0% amlodipine, 2.5%
losartan; P < or = 0.001); dizziness was the most common drug-related
CAE in the losartan group (6.0% losartan, 4.0% amlodipine). CONCLUSIONS:
In these patients with ISH, losartan and amlodipine produced comparable
clinically relevant reductions in SiSBP; however, losartan was
better tolerated, as evidenced by fewer CAEs and discontinuations
compared with amlodipine. Losartan may be considered for the initial
treatment of ISH.
Am Heart J. 2003 Jun;145(6):1030-5.
Effects of amlodipine on ischemia after percutaneous transluminal
coronary angioplasty: secondary results of the Coronary Angioplasty
Amlodipine Restenosis (CAPARES) Study.
Jorgensen B, Thaulow E; Coronary Angioplasty Amlodipine Restenosis
Study.
Department of Cardiology, Rikshospitalet, University of Oslo,
Oslo, Norway.
BACKGROUND: Despite successful coronary angioplasty (PTCA), patients
may have ischemia after the procedure because of the overall coronary
disease and luminal renarrowing at the lesion sites. The aim of
this study was to examine the effects of the calcium-channel blocker
amlodipine on post-PTCA ischemia. METHODS: In a prospective, double-blind
design, patients were randomized to receive 10 mg of amlodipine
or placebo 2 weeks before angioplasty. Exercise tests and 48-hour
ambulatory electrocardiography recordings were performed in 405
patients, 2 weeks before and 2 and 20 weeks (early and late) after
PTCA. RESULTS: There were no differences in clinical and angiographic
baseline characteristics between the treatment groups. Ischemia
and angina were equally distributed before PTCA, and no difference
in restenosis was found between the groups at follow-up. The incidence
of angina was significantly lower in the amlodipine group compared
with the placebo group both early and late after PTCA (P =.04
and.03). Exercise-induced ischemia was reduced by 40% (P =.009)
early and 34% (P =.02) late after PTCA in the amlodipine group,
and ischemia on ambulatory electrocardiography was reduced by
18% early and 28% late after PTCA compared with placebo (P =.06
and P =.009). CONCLUSION: Ischemia and angina occurred after successful
PTCA and were significantly reduced by amlodipine.
Methods Find Exp Clin Pharmacol. 2003 Apr;25(3):209-13.
Effect of amlodipine and hormone replacement therapy on blood
pressure and bone markers in menopause.
Zacharieva S, Shigarminova R, Nachev E, Kamenov Z, Atanassova
I, Orbetzova M, Stoynev A, Doncheva N, Borissova AM.
Clinical Centre of Endocrinology and Gerontology, Medical University,
Sofia, Bulgaria.
The aim of this study was to observe the effect of an 8-week treatment
with amlodipine, alone or in combination with hormone replacement
therapy (HRT), on blood pressure (BP), serum osteocalcin, bone-specific
alkaline phosphatase (B-ALP) and urine deoxypiridinoline in postmenopausal
osteoporotic women with mild-to-moderate arterial hypertension.
Both conventional clinical BP measurements and ambulatory blood
pressure monitoring (ABPM) were used. Twenty hypertensive menopausal
women with osteoporosis were randomly divided in two groups according
to the treatment regimens: amlodipine and amlodipine + HRT. Neither
treatment regimen significantly changed bone formation or bone
resorption markers. There were no significant differences in levels
of serum and urinary calcium and phosphorous or serum cholesterol
and low-density lipoprotein (LDL)-cholesterol after treatment
with amlodipine alone or in combination with HRT. Triglycerides
were significantly decreased and high-density lipoprotein (HDL)-cholesterol
was significantly increased after amlodipine treatment. Both treatment
regimens significantly decreased conventionally measured BP to
a similar extent. Amlodipine given alone lowered the midline estimating
statistic of rhythm (MESOR; mean 24-level) of systolic BP and
induced phase advances of the circadian rhythms of systolic, diastolic
and mean BP. When combined with HRT, amlodipine lowered the MESOR
and reduced the amplitude of systolic BP without any phase change.
In conclusion, amlodipine is effective in reducing BP in postmenopausal
women. The maintenance of a normal circadian BP pattern is also
influenced by supplementation with 17beta-estradiol. The 8-week
treatment with amlodipine alone and in combination with HRT is
not associated with a marked influence on bone metabolism.
Clin Ther. 2003 Jan;25(1):35-57.
Effect of amlodipine on systolic blood pressure.
Levine CB, Fahrbach KR, Frame D, Connelly JE, Estok RP, Stone
LR, Ludensky V.
MetaWorks Inc., Medford, Massachusetts 02155, USA.
BACKGROUND: Systolic hypertension is the most common form of hypertension,
particularly in people aged >60 years. Caused by decreased
compliance of large arteries, systolic hypertension is an independent
risk factor for cardiovascular disease. Recent studies have demonstrated
that it is more important to control systolic blood pressure (SBP)
than diastolic blood pressure (DBP). OBJECTIVE: The objective
of this study was to perform a systematic literature review to
examine the effectiveness of amlodipine in lowering SBP in a variety
of patient subgroups and clinical settings. METHODS: The literature
review methodology included identifying, selecting, appraising,
extracting, and synthesizing primary research studies. Following
an a priori protocol, published literature was searched from 1980
to 2001 using 3 electronic databases. A manual review of the reference
lists of recent review articles and all accepted studies was performed.
Parallel-group, randomized, controlled trials that included at
least 10 adults with baseline hypertension (SBP>or=140 mm Hg,
DBP>or=90 mm Hg, or both), included at least 1 arm randomized
to initial treatment with amlodipine monotherapy, had a minimum
treatment duration of 8 weeks, and reported baseline and end-point
blood pressure were included. RESULTS: Of 696 citations identified,
85 primary studies met all inclusion criteria. Comparable treatment
arms were pooled, and weightd mean SBP was calculated. In the
amlodipine monotherapy arms, which included >5000 patients,
SBP decreased by a mean of 17.5 mm Hg from baseline. The effect
of amlodipine in reducing SBP was greater in elderly patients
(age>or=60 years) and patients with author-defined isolated
systolic hypertension. The dose was titrated to achieve the target
blood pressure in 73 of 89 amlodipine treatment arms, whereas
16 treatment arms reported fixed doses. The median daily dose
was 5 mg (range, 1.25-15 mg) in both the fixed-dose and dose-titration
groups. CONCLUSIONS: In this review of the published literature,
amlodipine monotherapy was effective in reducing SBP. Antihypertensive
agents such as amlodipine warrant consideration for the management
of patients with inadequately controlled SBP.
Am J Hypertens. 2002 Dec;15(12):1042-9.
Effects of amlodipine fosinopril combination on microalbuminuria
in hypertensive type 2 diabetic patients.
Fogari R, Preti P, Zoppi A, Rinaldi A, Corradi L, Pasotti C, Poletti
L, Marasi G, Derosa G, Mugellini A, Voglini C, Lazzari P.
Department of Internal Medicine and Therapeutics, Clinica Medica
IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
BACKGROUND: The aim of this study is to compare the long-term
effect of amlodipine and fosinopril in monotherapy or in combination
on urinary albumin excretion (UAE) in hypertensive diabetic patients.
METHODS: We selected 453 hypertensive patients with type 2 diabetes
and microalbuminuria and randomized them to amlodipine (5 to 15
mg/day), fosinopril (10 to 30 mg/day), or amlodipine plus fosinopril
(5/10 to 15/30 mg/day) for a 3-month titration period. The nonresponder
patients or those complaining of side effects during the titration
period were discontinued (n = 144); the remaining 309 patients
were enrolled in the trial and treated with the same therapy for
4 years. Every 6 months, blood pressure (BP), heart rate (HR),
UAE, creatinine clearance, and glycosylated hemoglobin (HbA1c)
were evaluated. RESULTS: The combination therapy was more effective
in reducing BP than either drug alone at any time of the study
without affecting glucose homeostasis. All three treatments provided
a significant decrease in UAE during the 48-month study period.
However, this effect was more pronounced and became evident earlier
with fosinopril than with amlodipine monotherapy (after 3 v 18
months of therapy). In addition, the combination therapy provided
a greater antialbuminuric effect than the single drugs. This could
be due to the greater antihypertensive effects, although other
drug-specific effects cannot be excluded. The cardiovascular outcomes
were similar in the amlodipine and in the fosinopril group, but
they were lower in the combination group. CONCLUSIONS: These results
strengthen the rationale to use a calcium-antagonist/angiotensin
converting enzyme inhibitor combination in the treatment of hypertensive
patients with type 2 diabetes.
Z Kardiol. 2002 Oct;91(10):833-9.
The effect of amlodipine on exercise-induced pulmonary hypertension
and right heart function in patients with chronic obstructive
pulmonary disease.
Franz IW, Van Der Meyden J, Schaupp S, Tonnesmann U.
Klinik Wehrawald, BfA Schwarzenbacher Strasse 3 79682 Todtmoos,
Germany.
The aim of the study was to investigate the pulmonary vasodilator
effect of the dihydropyridine calcium channel blocker amlodipine
in patients with clinically stable chronic obstructive pulmonary
disease (COPD) and pulmonary hypertension (PH). Many patients
with COPD develop chronic PH and this may predict mortality in
this disorder. The treatment with calcium channel blockers is
accepted as a therapeutic strategy for primary pulmonary hypertension.
In twenty male patients (mean age 57+/-7 years) with clinically
stable COPD and PH, we investigated whether amlodipine could effectively
decrease pulmonary vascular resistance (PVR) and pulmonary arterial
pressure (PAP) and improve right heart function. PAP was recorded
by a balloon-tipped thermodilution catheter and cardiac output
was determined in triplicate by thermodilution at rest and during
exercise. In addition, blood gas values were determined from the
capillary blood of the earlobe. All measurements were done under
identical conditions before and after 18 days of chronic treatment:
with 10 mg amlodipine once daily starting with 5mg in the first
week. At a mean maximal achieved workload of 71.3+/-20 Watts,
amlodipine achieved a significant reduction in PVR (-13.4%; p<0.01)
and PAP (-12.1%; p<0.001) implying an improved right heart
function assessed by a significant reduction in mean right atrial
pressure (-20.6%; p<0.05). During the action of amlodipine
there were no significant changes in pulmonary gas exchange and
pulmonary capillary wedge pressure. Amlodipine given as a single
daily oral dose of 10mg is a safe and effective pulmonary vasodilator
in COPD patients with PH and leads to an improvement in right
heart function.
Anadolu Kardiyol Derg. 2001 Mar;1(1):14-6.
The effects of amlodipine on cerebral circulatory values in patients
with essential hypertension.
Alizade IG, Karayeva NT.
Department of Cardiology, Hospital of Ministry of Internal Affairs,
Baku, Azerbaijan.
OBJECTIVE: This study assessed the effects of calcium channel
blocker Amlodipine on the cerebral circulation in patients with
essential hypertension. METHODS: Cerebral circulation in 37 patients
with essential hypertension and 10 healthy subjects was assessed
using rheoplethysmography. In patients with essential hypertension
cerebral circulation values were also re-estimated after treatment
with Amlodipine (5-10 mg daily). RESULTS: The cerebral circulatory
parameters in hypertensive patients before treatment with Amlodipine
were different from those in healthy persons. Amlodipine along
with the reduction in systemic blood pressure caused attenuation
of cerebrovascular abnormalities: decrease in spastic signs and
increase in cerebral blood supply in patients with essential hypertension.
CONCLUSION: Amlodipine causes reduction of cerebral vascular resistance
and promotes improvement in arterial blood filling in patients
with essential hypertension. These changes in cerebral circulation
may be secondary to the increase of cardiac output--known effect
of Amlodipine.
Ann Cardiol Angeiol (Paris). 2000 Oct;49(7):423-30.
Validation of the therapeutic role of amlodipine in 31,946 French
hypertensive patients.
Dievart F, Pasquie JL, Bernaud C, Grolleau-Raoux R.
Clinique Villette, 18, rue Parmentier, 59240 Dunkerque, France.
Amlodipine, a dihydropyridine calcium channel blocker (CCB), with
a long duration of action, has been the subject of numerous controlled
studies which showed its effectiveness and good tolerance in arterial
hypertension in once-daily doses. We report the results of a large,
multicentric, French, prospective phase IV study which evaluated
the effectiveness and tolerance of amlodipine administered at
a rate of 5 to 10 mg in only one daily dose. We also assess the
evolution of the quality of life after 12 weeks of treatment among
31,946 hypertensive patients followed up to the ambulatory stage
by general practitioners. The response rate--defined as the patients
having had a reduction of 10 mmHg or more diastolic blood pressure--was
88%. The blood pressure standardization--defined by a diastolic
blood pressure lower than 90 mmHg--was achieved for 70% of the
patients. Amlodipine was administered in stand-alone therapy in
78% of the cases. The occurrence of an undesirable event was noted
in the course of treatment in 12% of the patients and justified
interruption of the treatment for 3.7% of the total population.
The index average of quality of life was improved by the end of
the 12-week treatment. This study carried out on a significant
number of hypertensive patients (n = 31,946) under real prescription
conditions confirms the efficacy and good tolerance of amlodipine,
as has already been demonstrated in the preliminary developmental
studies.
Can J Cardiol. 2000 Jul;16 Suppl D:5D-7D.
Overview of the prospective randomized evaluation of the vascular
effects of Norvasc (amlodipine) trial: PREVENT.
Mancini GB.
Vancouver Hospital and Health Sciences Centre, Vancouver, Canada.
The Prospective Randomized Evaluation of the Vascular Effects
of Norvase (amlodipine) Trial (PREVENT) was designed specifically
to assess if amlodipine can be shown to inhibit angiographic progression
of lesions 30% or less diameter stenosis. A carotid ultrasound
substudy was also undertaken. The antiatherosclerotic effects
were discordant in that minor coronary lesions were not affected,
whereas carotid intima-media thickness showed significantly less
progression in the amlodipine-treated patients. Moreover, significant
cardiac events, particularly admissions to hospital for unstable
angina and intervention, were significantly reduced in the amlodipine-treated
patients. This brief report provides an overview and assessment
of the implications of these findings.
Arch Intern Med. 2000 Feb 14;160(3):343-7.
Sex bias and underutilization of lipid-lowering therapy in patients
with coronary artery disease at academic medical centers in the
United States and Canada. Prospective Randomized Evaluation of
the Vascular Effects of Norvasc Trial (PREVENT) Investigators.
Miller M, Byington R, Hunninghake D, Pitt B, Furberg CD.
Department of Medicine, University of Maryland Medical Center,
Baltimore, USA.
BACKGROUND: The efficacy of lipid-lowering therapy (LLT) has been
well established for patients with preexisting coronary artery
disease (CAD). However, limited information is available assessing
the extent to which these medications are prescribed in academic
medical centers. METHODS: The use of LLT for patients with CAD
was prospectively evaluated in 825 men and women who were recruited
from 16 academic medical centers in the United States and Canada
to participate in the Prospective Evaluation of the Vascular Events
of Norvasc Trial (PREVENT). The assessment of LLT use during the
3-year trial was evaluated in patients receiving amlodipine therapy
and placebo; levels of low-density lipoprotein cholesterol (LDL-C)
were used to assess the impact of LLT. RESULTS: Despite a baseline
prevalence of LLT in 42% of men (38% in 1994), half of the patients
had high levels of LDL-C (>3.36 mmol [>130 mg/dL]). During
the subsequent 3 years, the prevalence of elevated LDL-C levels
dropped in men (29%) but remained stagnant in women (48%). These
changes were associated with increased LLT in men (55%) but not
in women (35%) (P = .04). In 1994, the LDL-C target goal (<2.59
mmol/L [<100 mg/dL]) was attained in 17% of men and 6% of women
(P = .006). At study completion in 1997, the LDL-C target goal
was achieved in 31% of men and only 12% of women (P = .001). CONCLUSIONS:
This study highlights the relatively low treatment rates of hyperlipidemia
among patients with CAD overall and women in particular who were
participating in a clinical trial at academic medical centers
in the United States and Canada. Because LLT has been proven to
reduce future cardiovascular events, these results suggest that
more intensive efforts should be promoted in order to maximize
CAD reduction.
J Cardiovasc Pharmacol. 1999;33 Suppl 2:S17-22.
Atheroprotection with amlodipine: cells to lesions and the PREVENT
trial. Prospective Randomized Evaluation of the Vascular Effects
of Norvasc Trial.
Tulenko TN, Brown J, Laury-Kleintop L, Khan M, Walter MF, Mason
RP.
Department of Physiology, Biochemistry and Surgery, Allegheny
University of the Health Sciences, Philadelphia, Pennsylvania
19129, USA.
Oxidized lipid and calcium regulatory abnormalities appear to
play important roles in early atherogenesis secondary to cholesterol
enrichment of the cell membrane in endothelial and arterial smooth
muscle cells (SMCs). However, the link between the two is poorly
understood. The findings reviewed here demonstrate that amlodipine
has membrane-modifying and antioxidant actions at the cell membrane
level in addition to its classical calcium channel blocking properties.
These multiple pharmacologic actions may explain the cellular
mechanisms of the atheroprotective effects of amlodipine in spontaneous
atherogenesis and in accelerated atherosclerotic syndromes. Recent
animal model studies have demonstrated that amlodipine inhibits
the progression of atherosclerotic lesions and protects against
restenosis after angioplasty. Amlodipine inhibits the cholesterol-induced
increase in calcium permeability in SMCs, and has been shown to
repair abnormalities in SMC membrane structure. Recent data have
also demonstrated that amlodipine has a marked antioxidant action
in membrane bilayers enriched with polyunsaturated fatty acids.
However, these findings have been in animal models only; the efficacy
of amlodipine in atheroprotection in humans cannot be predicted.
The PREVENT trial has therefore been launched to examine the atheroprotective
potential of amlodipine in spontaneous lesion development in humans
with ischemic heart disease and in the prevention of restenosis
after angioplasty.
Rev Med Panama. 1993 Sep;18(3):233-7.
Experience with amlodipine (Norvasc) in the management of arterial
hypertension.
Rodriguez N, Dominguez B.
Servicio de Medicina Interna y Cardiologia, Complejo Hospitalario
Dr. Arnulfo Arias M., Caja de Seguro Social.
The authors report the results of therapy with amlodipine in 20
patients with mild or moderate hypertension (diastolic pressure
between 95 and 115 mmHg). Amlodopine was administered in a dose
of either 5 or 10 mg once a day for 12 weeks. None of the patients
had a history of congestive heart failure. Eleven patients were
men between 27 and 89 years of age (average age was 52.6 years).
There was a significant decrease in systolic blood pressure (from
161 to 141 mm Hg or -12.4%) and in diastolic blood pressure (from
103 to 86 mm Hg or -16.5%). Heart rate remained between 78 and
77 beats per minute. Only one patient experienced palpitations
and two complained of mild, transient giddiness while on this
therapy.
MMW Fortschr Med. 2004 Dec 9;146:115-21.
[Safety and antihypertensive efficacy of the dihydropyridine calcium
antagonist Amlodipine besylate--results from an observational
study in 9,672 patients] [Article in German]
Keck M, Sauerbrey-Wullkopf N, Regourd E, Clemens A.
Fachklinik fur Herz- und Kreislaufkrankheiten, Drei-Burgen-Klinik,
Bad Munster am Stein.
OBJECTIVES: This observational study investigated prescription
behavior and the efficacy and safety of Amlodipine besylate in
hypertensive patients. METHODS: 9,672 hypertensive patients were
treated with Amlodipine besylate 5-10 mg/day for 12 weeks. At
the end of the observation period, the participating physicians
were asked to give their subjective evaluation of the efficacy
and safety of treatment with Amlodipine besylate as well as their
therapeutic considerations regarding the use of Amlodipine besylate.
RESULTS: 55.2% of the patients received Amlodipine besylate in
combination with other antihypertensive agents. The mean baseline
blood pressure was 168.0/96.7 mmHg and the mean blood pressure
reduction achieved at the end of the observation period was -28.5/-14.5
mmHg. In 80.3% of the total population, a reduction to diastolic
blood pressure values of < 90 mmHg was achieved. A reduction
to systolic blood pressure values of < 140 mmHg was obtained
in 41.6% of the patients. Adverse events were reported by only
1.2% of the patients. For the vast majority of the patients, efficacy
(96.6%) and safety (98.9%) were rated "very good" or
"good" by their physicians. 24-hour efficacy with once
daily dosing was given as the most important argument for using
Amlodipine besylate. CONCLUSION: The observation study confirmsthat
Amlodipine besylate is an effective and safe antihypertensive
drug both in mono and combination therapy.
