Nicardipine: A Hypotensive Dihydropyridine-Type Calcium Antagonist with a Peculiar Cerebrovascular Profile
Nicardipine: A Hypotensive Dihydropyridine-Type Calcium Antagonist with a Peculiar Cerebrovascular Profile
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DOI：
10.1080/10641960802580190
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发表时间：
2008-01-01
影响因子：
12.3
通讯作者：
Veglio, Franco
中科院分区：
文献类型：
--
作者：
Amenta, Francesco;Tomassoni, Daniele;Veglio, Franco
控制血压可防止脑血管病变、中风和血管性痴呆(VAD)的发生。脑血管疾病越来越多地被认为是认知障碍和痴呆的原因，主要发生在老年人。尼卡地平是一种二氢吡啶类钙通道阻滞剂(CCB)，大约30年前开发出了一种特殊的脑血管特征。本研究回顾了尼卡地平在与脑血管损伤相关的病理中使用尼卡地平的主要对照临床研究，如蛛网膜下腔出血(SAH)、急性中风和VaD。SAH是CCBS的主要脑血管指征。在这一适应症中，CCBS可预防血管痉挛并改善临床结果。尼莫地平在这一适应症上代表了CCB更多的研究。先前的研究没有显示尼卡地平与尼莫地平相比在SAH中有明显的优势。一种使用尼卡地平缓释植入物的较新方法显示，严重SAH后血管痉挛的发生率降低，延迟的缺血缺损率降低，临床结果得到改善。对照试验表明，这种药物在预防中风方面是有效的。越来越多的证据表明，一些CCBS对VAD或混合性退行性和血管性痴呆有一定的好处。在这种情况下，尼卡地平已经在大约6000名患者中进行了研究，超过60%的接受治疗的患者的认知恶化有所改善。尼卡地平显著的降压活性及其在认知领域的安全性和有效性表明，它在治疗血管性认知障碍以及降低中风高危患者的复发风险方面值得重新考虑。
Control of blood pressure protects against the development of cerebrovascular lesions, stroke, and vascular dementia (VaD). Cerebrovascular disease is increasingly recognized as a cause of cognitive impairment and dementia primarily in the elderly. Nicardipine is a dihydropyridine-type calcium channel blocker (CCB) with a peculiar cerebrovascular profile developed approximately 30 years ago. This study has reviewed the main controlled clinical studies investigating the use of nicardipine in pathologies associated with cerebrovascular injury, such as subarachnoid haemorrhage (SAH), acute stroke, and VaD. SAH is a main cerebrovascular indication of CCBs. In this indication, CCBs prevent vasospasm and improve clinical outcomes. Nimodipine represents the CCB more investigated in this indication. Former studies did not demonstrate a clear advantage of nicardipine versus nimodipine in SAH. A more recent approach using implants of nicardipine prolonged-release showed a decreased incidence of vasospasm, delayed ischemic deficits, and improved clinical outcome after severe SAH. Controlled trials have shown the effectiveness of the drug in preventing stroke. Increasing evidence suggests some benefit of some CCBs in VaD or mixed degenerative and vascular dementia. In this setting, nicardipine has been investigated in approximately 6,000 patients, with an improvement of cognitive deterioration in more than 60% of patients treated. The pronounced anti-hypertensive activity of nicardipine and its safety and effectiveness in cognitive domain suggest its reconsideration in the treatment of cognitive impairment of vascular origin as well as for reducing the risk of recurrent stroke in patients at high risk of it.