Nicardipine for systemic hypertension: Effects on blood pressure and target organ function

Abstract

Nicardipine has been shown to lower blood pressure in patients with uncomplicated hypertension as well as in patients with concomitant renal impairment, coronary artery disease or congestive heart failure. The decrease in blood pressure induced by nicardipine is related to a concurrent decrease in total peripheral vascular resistance. The antihypertensive actions of nicardipine are maintained during long-term administration without the development of tachyphylaxis. In patients receiving diuretics or β blockers, the addition of nicardipine has been shown to produce an additional decrease in blood pressure. The combined use of nicardipine and β blockers may be beneficial in the treatment of hypertension: the increase in peripheral vascular resistance during β blockade may be prevented by nicardipine-induced vasodilation; conversely, β blockers may prevent reflex tachycardia and other consequences of peripheral vasodilatation. Although nicardipine may increase the heart rate acutely, tachycardia does not occur during long-term therapy. Preliminary data suggest that nicardipine exerts potent antihypertensive effects in patients with renal insufficiency without altering renal parameters. In patients with normal renal function, nicardipine has been shown to cause acute natriuresis and an increase in renal blood flow and glomerular filtration rate. Nicardipine also has a favorable effect on peripheral and cerebral blood flow. Like other dihydropyridines, nicardipine appears to have an antiatherogenetic effect in the experimental model. Short-term therapy with nicardipine does not affect serum lipid levels. Results from several studies suggest that nicardipine is an effective antihypertensive agent that can be used as monotherapy or in combination with other drugs such as β blockers or diuretics. Nicardipine may also have a favorable effect on target organ function and on various circulatory parameters without causing adverse metabolic or biochemical consequences.