Metabolic effects of manidipine.
The calcium channel antagonists (CCAs) were originally introduced as vasodilators for the treatment of coronary heart disease, but are now also noted for their clinical efficacy in the management of hypertension. Data from large clinical studies have shown that CCAs are not associated with the undesirable metabolic effects (e.g. worsening of dyslipidemia and reduction of insulin sensitivity) seen with older agents such as thiazide diuretics and beta-adrenoceptor antagonists (beta-blockers) that are used to treat hypertension. Indeed, reductions in cardiovascular risk and rates of onset of new cases of diabetes mellitus have been reported in trials in patients with hypertension treated with CCAs. These beneficial effects extend beyond those expected to accompany reductions in BP. Until recently, the biochemical effects underlying these metabolic changes were only poorly understood, but pharmacologic studies have now started to shed more light on these issues. Of particular interest are studies with manidipine, some of which suggest that this agent may be associated with greater improvements in insulin sensitivity and may have better renal protective properties than other CCAs. Confirmation of potential differences among CCAs in terms of the relative magnitude of any beneficial metabolic effects requires further study. Ongoing research is expected to clarify further the action of these agents at the cellular level and to assist with the optimization of antihypertensive therapy, particularly in patients with elevated cardiovascular risk profiles.
Cavalieri
Luca
L
Promedica Srl, Parma, Italy; Medical Department, Chiesi Famaceutici SpA, Parma, Italy.
Cremonesi
Giovanni
G
D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000494:pharmacology* / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004095:Dihydropyridines / Q000494:pharmacology* / Q000627:therapeutic use*; D004730:Endothelium, Vascular / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D007674:Kidney Diseases / Q000517:prevention & control; D008055:Lipids / Q000097:blood; D015201:Meta-Analysis as Topic; D024821:Metabolic Syndrome / Q000188:drug therapy* / Q000517:prevention & control; D009578:Nitrobenzenes; D047495:PPAR gamma / Q000819:agonists; D010879:Piperazines; D017410:Practice Guidelines as Topic
D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004095:Dihydropyridines; D007328:Insulin; D008055:Lipids; D009578:Nitrobenzenes; D047495:PPAR gamma; D010879:Piperazines; C054218:manidipine