Introduction

Article Abstract:

Calcium antagonists, such as verapamil, are a class of drugs that exert their effect by interfering with the passage of calcium into cells; this blockade has been shown to confer therapeutic benefits in a wide variety of disease states, including cardiovascular disorders (most notably high blood pressure, cardiac arrhythmia and coronary heart disease). The widespread involvement of calcium in biological processes makes it a natural target for continued, extensive study; at a conference in New Orleans in March of 1990 entitled "Calcium antagonists: current use and future implications," progress in the study of calcium antagonists was reviewed and future directions were discussed. For example, the interaction between calcium antagonists and other cardiovascular therapeutic agents such as diuretics and beta adrenergic receptor blockers is an important consideration, and treatment regimens must often be individualized for patients' safety and well-being. Another point raised in the symposium was that frequently, the addition of diuretics (or initiation of dietary sodium restriction) does not improve the antihypertensive (blood pressure-lowering) effect of verapamil. Verapamil also appears to have protective effects against chronic and acute kidney failure, which may result from the biochemical alterations resulting from reduced calcium uptake by the kidney. Additionally, verapamil may reduce the incidence of rejection episodes following kidney transplantation, both by reducing the hypertensive effects of cyclosporine (a drug commonly given to transplant patients to suppress the response of the immune system) as well as increasing its immunosuppressive effects. The full range of beneficial effects conferred by verapamil (and other newly developed, more specific calcium antagonists) remains to be described, but at present, such drugs offer an effective and extraordinarily safe tool in the treatment of high blood pressure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Calcium channel blockers

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Cardiovascular risk reduction: the role of antihypertensive treatment

Article Abstract:

A large number of risk factors for the development of cardiovascular disease have been identified. Many of these, including cigarette smoking, upper body obesity, glucose intolerance, physical inactivity, personality type, hyperinsulinemia, left ventricular hypertrophy, hypercholesterolemia, and hypertension, are alterable either by medical approaches or by changes in lifestyle. Hypertension, or high blood pressure, has been particularly implicated in mortality associated with stroke, coronary artery disease, and acute myocardial infarction (heart attack). In 14 different independent trials, the effects of antihypertensive (blood pressure-lowering) treatments on mortality have been assessed in over 37,000 patients. In patients given a variety of antihypertensive treatments (primarily diuretics and beta blockers), blood pressure was reduced by an average of six millimeters of mercury, compared with placebo-treated patients. The mortality from stroke was reduced by 42 percent in treated patients; however, the rate of death from coronary artery disease was only reduced by 14 percent. The most likely explanation for this discrepancy is the adverse effect of diuretics and beta blockers on insulin resistance, glucose tolerance, and lipid levels, which are risk factors in and of themselves for the development of coronary artery disease. The increased use of drugs that have beneficial effects on many coronary artery disease risk factors, such as angiotensin-converting-enzyme (ACE) inhibitors, should reduce mortality in a similar subject population. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cardiovascular diseases, Prevention, Risk factors, Coronary heart disease, Lipid metabolism

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Introduction

Article Abstract:

The enzyme renin is produced by the kidneys. Renin converts the blood protein angiotensinogen to angiotensin I, which is then converted to angiotensin II by angiotensin-converting enzyme (ACE). Angiotensin II is a potent vasopressor, in that it constricts blood vessels, and also increases the production and release of the mineralocorticoid hormone aldosterone from the adrenal glands. Aldosterone controls the metabolism of sodium, chloride, and potassium. Agents which prevent the action of ACE and the formation of angiotensin II have been used to treat hypertension, or abnormally high blood pressure. ACE inhibitors are effective, well-tolerated, and also prevent and reduce changes in organ structure associated with long-term hypertension. The restoration of organ structure by ACE inhibitors contributes to improved function under conditions of left ventricle and blood vessel hypertrophy (enlargement). In addition to lowering blood pressure, protection of blood vessels has become an important aspect in the therapy of hypertension. The ACE inhibitor cilazapril prevents the overgrowth of smooth muscle cells and cells lining the blood vessels. Cilazapril, which was developed by computer modeling techniques, has a long-lasting antihypertensive effect and is well-tolerated. A symposium held in February 1989 focused on clinical aspects of the ACE inhibitor cilazapril. (Consumer Summary produced by Reliance Medical Information, Inc.)

ACE inhibitors, Angiotensin converting enzyme inhibitors

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