The combined effect of calcium channel blocker Lercanidipine and antioxidants on low-grade systemic inflammation parameters in essential hypertension patients.
OBJECTIVE
The influence of oxidative stress (OS) and inflammation on up-regulation of blood pressure (BP) has been well established. Peripheral polymorphonuclear leukocytes (PMNLs) are primed in essential hypertension (EH) patients, releasing uncontrolled superoxide anion contributing to OS in these patients. PMNL priming correlates with PMNL intracellular calcium [Ca2+]i. Previous studies have shown that treatment by calcium channel blockers lowers BP, OS and inflammation. In the same time, there are some trials showing down regulation influence of ''anti-oxidative'' drugs as Vitamin E and C to inflammation and OS. The data of clinical significance of anti-oxidative drugs to BP is controversial. The aim of this paper was to evaluate the benefit of combined treatment by calcium channel blockers (Lercanidipine) and antioxidative drugs (Vitamins C and E) on BP and on parameters of inflammation and OS.


METHODS
Sixteen new diagnosed patients with mild to moderate BP were sampled to 2 groups after randomization by age, sex, and mean arterial pressure (MAP), cholesterol and glucose level. The first group was treated by Lercanidip-ine only, the second group by combination of Lercanidipine and antioxidative drugs both for 6 months. PMNL priming was assessed by the rate of superoxide release from separated, phorbol ester-stimulated PMNLs and by PMNL-CD11b level. Inflammation was reflected by plasma C-reactive protein (CRP) and albumin levels, white blood cells (WBC) and PMNL counts and by PMNL apoptosis.


RESULTS
In both groups, BP decreased after 6 months of treatment, and in a more pronounced manner following the combined treatment. In both groups PMNL priming parameters remained unchanged after 6 months of treatment, with transient differences between the two groups during the experimental period. In both groups inflammation parameters remained unchanged after 6 months of treatment, without difference between the two groups, except a pronounced decrease in the percentage of apoptotic PMNLs in the combined treatment group.


CONCLUSIONS
Our trial shows a clinical benefit combining calcium channel blockers treatment with antioxidants in BP treatment, although it did not reveal significant influence of complementation of antioxidants to calcium channel blockers on OS and inflammation parameters. Additional clinical and laboratory investigations are needed to clear this issue. Conflicting data are reported on the influence of vitamins E and C on OS and inflammation together with controversy regarding anti-oxidative drugs and their effect on BP.
Farah
R
R
Department of Internal Medicine B, Ziv Medical Center, Safed, Israel. Raymond.F@ziv.health.gov.il
Shurtz-Swirski
R
R
D000328:Adult; D000975:Antioxidants / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D004095:Dihydropyridines / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007249:Inflammation / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged
D000975:Antioxidants; D002121:Calcium Channel Blockers; D004095:Dihydropyridines; C060343:lercanidipine