title: Nicardipine use in cerebrovascular disease: a review of controlled clinical studies.
abstract: Nicardipine is a dihydropyridine-type Ca(2+) channel blocker (CCB) with strong antihypertensive activity and with a peculiar cerebrovascular profile. This paper has reviewed the main controlled clinical studies on nicardipine in pathologies associated with cerebrovascular impairment. Subarachnoid haemorrhage (SAH) is managed with CCBs to prevent vasospasm and improve clinical outcomes. Nimodipine is the CCB licensed for this indication. Former studies did not demonstrate an advantage of nicardipine versus nimodipine in SAH. A more recent approach administering the drug intra-arterially or using implants of nicardipine prolonged-release showed a decreased incidence of vasospasm, delayed ischemic deficits and improved clinical outcome after severe SAH. Nicardipine is recommended for elevated blood pressure after acute ischemic stroke or intracerebral haemorrhage and is effective in prevention of stroke. More recent investigations were focused on the treatment of cognitive deterioration of vascular origin. In this setting nicardipine has been investigated in more than 6000 patients, with improvement of cognitive deterioration in more than 60% of patients treated. The anti-hypertensive activity of nicardipine, its safety and effectiveness in cognitive domain, suggests re-considering this drug in the treatment of cognitive impairment of vascular origin and for reducing the risk of recurrent stroke in patients at high risk of it.
authors.affiliation: Clinical Research Centre, Department of Experimental Medicine and Public Health, University of Camerino, 62032 Camerino, Italy. Francesco.amenta@unicam.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Amenta
authors.forename: Alessia
authors.initials: A
authors.lastname: Lanari
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Mignini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Silvestrelli
authors.forename: Enea
authors.initials: E
authors.lastname: Traini
authors.forename: Daniele
authors.initials: D
authors.lastname: Tomassoni
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002561:Cerebrovascular Disorders / Q000188:drug therapy*; D003071:Cognition / Q000187:drug effects; D003072:Cognition Disorders / Q000188:drug therapy; D018849:Controlled Clinical Trials as Topic; D015140:Dementia, Vascular / Q000188:drug therapy; D006801:Humans; D009529:Nicardipine / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D009529:Nicardipine