Лерканидипин в лечении артериальной гипертензии

Abstract

Aim: To search the literature assessing lercanidipine effectiveness, tolerability, and benefits in arterial hypertension (AH) treatment. Data sources: The literature search was performed using MEDLINE (1966 – September 2006), EMBASE Drugs and Pharmacology (1980 – September 2006), and Current Contents/Clinical medicine (Week 24, 2005 – Week 30, 2006). Medication instructions were also studied for lercanidipine, nifedipine, and amlodipine, to compare adverse event information. Study and data selection: The English-language papers presenting clinical trials, abstracts, and literature reviews were included. Data synthesis: Lercanidipine is a new dihydropyridine calcium antagonist (CA), used for AH treatment. Although the medication is not available in USA, it is widely used in other countries. In two randomised controlled studies, including 400 patients with mild to moderate AH, lercanidipine effectiveness was similar to that in two other dihydropyridine CA – felodipine and slow-release nifedipine, as demonstrated by a significant decrease in systolic and diastolic blood pressure (SBP, DBP) levels after four weeks. In a longer study (12 months), lercanidipine (10 mg/d) normalised BP in 49% of the patients as soon as after 4 weeks of the therapy. A post-marketing study, including 9500 patients, confirmed the previous results: in 64%, DBP level reached 90 mm Hg or lower, and in 32%, BP was controlled (<140/90 mm Hg). In elderly patients, lercanidipine, similar to lacidipine and nifedipine, demonstrated a decrease in DBP comparable to that for nifedipine (-18,3 and -17,7 mm Hg, respectively). In contrast to the other dihydropyridine CA, lercanidipine is characterized by lower rates of adverse effects (lower leg edema, in particular). One study showed that fewer participants stopped their treatment due to adverse effects in the lercanidipine (0,9%) and nifedipine (3,8%) groups than in the felodipine group (4,5%). Lercanidipine also demonstrated antihypertensive activity similar to that in other antihypertensive medications, such as atenolol, captopril, and losartan. Conclusions: Lercanidipine could be used as a first-choice medication for AH treatment, since the available literature data confirm its comparative effectiveness and better tolerability, comparing to other antihypertensive agents. Further randomised double-blind clinical trials should be performed to clarify the place of lercanidipine among other medications for AH treatment.