Azelnidipine, a long-acting calcium channel blocker, could control hypertension without decreasing cerebral blood flow in post-ischemic stroke patients. A 123I-IMP SPECT follow-up study.
Azelnidipine, a long-acting calcium channel blocker, is highly lipid soluble and selective for the vascular wall, and is expected to have an increasing effect on cerebral blood flow (CBF). The aim of this study is to investigate its safety and efficacy in stroke patients in the chronic stage as far as CBF is concerned using N-isopropyl-p-(123)I-iodo amphetamine ((123)I-IMP) single-photon emission computed tomography (SPECT). The patients were orally administered 8 or 16 mg of azelnidipine. Regional CBF was evaluated by (123)I-IMP SPECT using three-dimensional stereotactic region-of-interest (ROI) template (3D-SRT), a technique using anatomical standardization and ROI template consisting of 636 ROIs for the whole brain. Mean hemispheric CBF was defined as the mean value of the corpus callosum, and the precentral, central, parietal, angular and temporal gyri. Mean hemispheric and regional CBF after 1, 3 and 6 months were analyzed using a one-way repeated-measures analysis of variance. Ten post-ischemic stroke patients with hypertension were enrolled between October 2005 and October 2007, and all of them were well controlled with normal blood pressure (before: 172.3+/-16.6/88.4+/-14.0 mm Hg; 6 months: 128.7+/-15.9/70.9+/-10.1 mm Hg). No vascular events were observed during the study period. The mean hemispheric CBF was maintained during the study period (before: 46.0+/-9.7 ml per 100 g per min; 6 months: 49.3+/-11.1 ml per 100 g per min). The regional CBF was also maintained. In the chronic stage of ischemic stroke, azelnidipine could safely decrease systemic blood pressure without decreasing CBF.
Watanabe
Masaki
M
Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. masakiwatanabe3@gmail.com
Hirano
Teruyuki
T
Okamoto
Sadahisa
S
Shiraishi
Shinya
S
Tomiguchi
Seiji
S
Uchino
Makoto
M
D000368:Aged; D001383:Azetidinecarboxylic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging*; D002121:Calcium Channel Blockers / Q000494:pharmacology*; D002544:Cerebral Infarction / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004095:Dihydropyridines / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D007091:Image Processing, Computer-Assisted; D020367:Iofetamine; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology*; D015899:Tomography, Emission-Computed, Single-Photon
D002121:Calcium Channel Blockers; D004095:Dihydropyridines; D019275:Radiopharmaceuticals; D001383:Azetidinecarboxylic Acid; D020367:Iofetamine; C061679:azelnidipine