Calcium channel blockers CCBs hypertension

Dihydropyridine calcium channel blockers (CCBs) have been used for many years in the treatment of angina pectoris and hypertension (81). Their mechanism of action is based on inhibition of the smooth muscle L-type calcium current, thereby... 

Pfizer s Procardia XL is a once daily calcium channel blocker (CCB) for hypertension and angina. It delivers nifedipine via Alza s osmotic pump, a patented high-tech sustained-release (SR) formulation. Several generic companies are currently seeking FDA approval for an A/B substitute using low-tech SR formulations. The generic companies claim that they are not infringing Pfizer s patent estate, which includes ... 

Three landmark placebo-controlled clinical trials have established the benefits of both hypertension treatment and diuretic therapy. The Systolic Hypertension in the Elderly Program (SHEP), the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension), and the Medical Research Council (MRC) trial " showed significant reductions in stroke, myocardial infarction, and aU-cause cardiovascular disease and mortality with thiazide diuretic-based therapy versus placebo. These trials allowed for /3-blockers as add-on therapy for BP control. Newer agents (i.e., ACE inhibitors, angiotensin II receptor blockers [ARBs], and calcium channel blockers [CCBs]) were not available at the time of these studies. However, subsequent clinical trials have compared these newer antihypertensive agents (ACE inhibitors, ARBs, and CCBs) to diuretics." These data show similar effects, but most trials used a prospective, open-label, blinded end point (PROBE) study methodology that is... 

BP, blood pressure CCB, calcium channel blocker agent DBP, diastolic blood pressure SBP, systolic blood pressure. (Adapted from JNC 7 Modified from Saseen JJ, Carter BL. Hypertension. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 194, with permission.)... 

The calcium channel blockers also effective treatments for hypertension in patients with CKD but without diabetes. However, as was mentioned previously, only the nondihydropyridine CCBs have data suggesting a reduction in the rate of decline of renal function. There are currently no data to suggest that higher doses of nondihydropyridine CCBs are needed to elicit a reduction in proteinuria as compared to a reduction in blood pressure. 

FIGURE 17-6. Algorithm for the treatment of atrial fibrillation and atrial flutter. Sx = symptoms AVN = AV node DCC = direct-current cardioversion CCB = calcium channel antagonist (verapamil or diltiazem) BB = jS-blocker ASA = aspirin OHD = organic heart disease AADs = antiarrhythmic drugs INR = international normalized ratio MVD = mitral valve disease CHF = congestive heart failure HTN = hypertension DM = diabetes mellitus. 

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