Document Detail


Efficacy of an L- and N-type calcium channel blocker in hypertensive patients with neurovascular compression of the rostral ventrolateral medulla.
MedLine Citation:
PMID:  19521420     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The rostral ventrolateral medulla is an important regulation center of sympathetic nerve activity. Several clinical studies have indicated a possible association between essential hypertension and neurovascular compression of the rostral ventrolateral medulla. We have found that patients with essential hypertension and neurovascular compression of the rostral ventrolateral medulla by adjacent arteries have increased sympathetic nerve activity and that microvascular decompression of the rostral ventrolateral medulla normalizes blood pressure and sympathetic nerve activity. Although sympatholytic agents are expected to lower blood pressure in these patients, this remains to be clarified. In this study, we evaluated the effect of cilnidipine, a calcium channel blocker that blocks both vascular L-type and sympathetic N-type Ca(2+) channels in hypertensive patients with neurovascular compression. Using high-resolution magnetic resonance imaging, 46 patients with untreated essential hypertension were distributed into those with and without neurovascular compression of the rostral ventrolateral medulla. All patients were prescribed 10 mg of cilnidipine for 16 weeks. Office and home blood pressure, plasma norepinephrine and left ventricular mass index were measured by echocardiography before and after cilnidipine treatment, and changes were compared between the two groups. At baseline, plasma norepinephrine was significantly higher in patients with neurovascular compression. Decreases in office and home blood pressure, plasma norepinephrine and left ventricular mass index were significantly greater in patients with neurovascular compression. These results suggest that cilnidipine lowers blood pressure by inhibiting enhanced sympathetic nerve activity and reduces left ventricular mass in hypertensive patients with neurovascular compression of the rostral ventrolateral medulla.
Authors:
Yasuko Aota; Satoshi Morimoto; Takao Sakuma; Tatsuyori Morita; Fusakazu Jo; Nobuyuki Takahashi; Minoru Maehara; Koshi Ikeda; Satoshi Sawada; Toshiji Iwasaka
Publication Detail:
Type:  Journal Article     Date:  2009-06-12
Journal Detail:
Title:  Hypertension research : official journal of the Japanese Society of Hypertension     Volume:  32     ISSN:  1348-4214     ISO Abbreviation:  Hypertens. Res.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-08-05     Completed Date:  2009-12-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9307690     Medline TA:  Hypertens Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  700-5     Citation Subset:  IM    
Affiliation:
Second Department of Internal Medicine, Kansai Medical University, Osaka 573-1191, Japan. aotay@hitakata.kmu.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / adverse effects,  therapeutic use*
Blood Pressure / drug effects,  physiology
Calcium Channel Blockers / adverse effects,  therapeutic use*
Calcium Channels, L-Type / drug effects*
Calcium Channels, N-Type / drug effects*
Dihydropyridines / therapeutic use
Echocardiography
Female
Heart Rate / drug effects,  physiology
Humans
Hypertension / complications*,  drug therapy*,  pathology
Magnetic Resonance Imaging
Male
Medulla Oblongata / pathology*
Middle Aged
Nerve Compression Syndromes / complications*,  pathology
Norepinephrine / blood
Ventricular Function, Left / drug effects
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Calcium Channel Blockers; 0/Calcium Channels, L-Type; 0/Calcium Channels, N-Type; 0/Dihydropyridines; 132203-70-4/cilnidipine; 51-41-2/Norepinephrine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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