Mitigation of calcium channel blocker-related oedema in hypertension by antagonists of the renin-angiotensin system.
This review is aimed at examining calcium channel blocker (CCB)-related oedema and how this can be attenuated through the use of agents that inhibit the renin-angiotensin system. CCBs are effective antihypertensive agents, but their propensity for causing oedema may reduce compliance. A review of the literature has indicated that the absolute incidence of this side effect is difficult to determine because reported rates vary widely, a factor that may stem from differences in the surveillance technique (active vs passive). In a recent trial incorporating active surveillance, 25% of patients who received amlodipine 10 mg per day experienced oedema. CCB-induced oedema is caused by increased capillary hydrostatic pressure that results from preferential dilation of pre-capillary vessels. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) cause post-capillary dilation and normalize hydrostatic pressure, and are thus ideally suited for prevention/reversal of CCB-induced oedema. The efficacy of this strategy was proven using both subjective and objective techniques. ARB/CCB and ACEI/CCB combination therapy is also more effective than CCB monotherapy in controlling blood pressure. These combinations represent an important advance in the management of hypertension.
de la Sierra
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Hypertension Unit, Department of Internal Medicine, Hospital Clinic 170-Villarroel, Barcelona 08036, Spain. ASIERRA@clinic.ub.es
D017311:Amlodipine / Q000008:administration & dosage / Q000009:adverse effects; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D004487:Edema / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D055118:Medication Adherence; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D017311:Amlodipine