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The role of lercanidipine in the treatment of hypertension: Blood pressure control and beyond Claudio Borghi Department of Internal Medicine, Aging and.

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Presentation on theme: "The role of lercanidipine in the treatment of hypertension: Blood pressure control and beyond Claudio Borghi Department of Internal Medicine, Aging and."— Presentation transcript:

1 The role of lercanidipine in the treatment of hypertension: Blood pressure control and beyond Claudio Borghi Department of Internal Medicine, Aging and Kidney Diseases University of Bologna, Bologna Italy

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3 Choice of Antihypertensive Drugs Five major classes of antihypertensive agents are considered suitable for the initiation and maintenance of antihypertensive treatment, alone or in combination. Thiazide diuretics, Calcium antagonists, ACE inhibitors, Angiotensin receptor antagonists β- blockers ESH-ESC Guidelines J Hypertens 2007;25: Reappraisal of EU Guidelines, J Hypertens 2009

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5 Elevated lipophilicity (15 times vs. amlodipine) High affinity for vascular membrane - Short plasma half-life Prolonged tissue half-life High selectivity for vascular tissue - Lack of negative inotropic effect - Increased vascular protection Pharmacokinetic properties not affected by age Double route of excretion (renal and hepatic) No major drug-to-drug interaction

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7 Circo A. J Cardiovasc Pharmacol, 1997 P<0.001 Changes vs. baseline p<0.001 ns SBP DBP HR (mmHg) (mmHg) (b/min)

8 Circo A, J Cardiovasc Pharmacol, 1997 (BP 10%) % patients

9 Ribstein J et al, J Hypertens 2002 P<0.05 Office BP Home BP Blood pressure (mmHg)

10 Barbagallo M et al, Aging Clin Exp Res, 2000 P<0.001 P<0.01 Blood pressure (mmHg)

11 Hemodynamic indices before and after 10- weeks of antihypertensive treatment in patients with ISH P<0.001 P<0.002 P<0.02 Mackenzie IS et al, Hypertension 2009

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13 Regression of LVH (vs. Losartan) - Fogari R et al, J Hypertens 2000 Improvement of endothelium - dependent vasodilatation - Taddei S et al, Hypertension 2003 Balanced effects on renal vasculature - Sabatini M et al, Hypertension 2000 Preservation of impaired renal function - Robles NR et al, Ren Fail 2005

14 Antioxidant effect of Lercanidipine, NO restoration and endothelial function in hypertensive patient. LERCANIDIPINE + Taddei S et al Hypertension 2005

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16 Dalla Vestra M et al, Diab Nutr Metab, 2004 P<0.05 Lercanidipine Ramipril

17 RENAAL Study: 6-month reduction of proteinuria and cardiovascular outcome Albuminuria reduction (%) Hazard ratio for cardiovascular event CV Endpoint Albuminuria reduction (%) Hazard ratio for heart failure Heart Failure De Zeeuw et al; Circulation 2004

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19 Viviani GL et al, J Cardiovasc Pharmacol 2002 *p<0.05 vs B * * * * * * * * * * * * * * * * * * * * * * * * Systolic BP Diastolic BP Fasting blood glucose HbA 1 mmHg mg/dL %

20 Mechanism of interaction between BK, AT-II, NO and glucose transport Henriksen EJ & Jacob S, J Cell Physiol 2003 Lercanidipine..

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22 % of patients with AEs Barrios V et al, Blood Pressure 2002 DrugStudy% AEs Nifedipine GITSINSIGHT49.0% AmlodipineVALUE39.2%

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24 Romito R et al, Am J Hypertens, 2003 P<0.05 Treatment discontinuation for AEs Blood pressure DBP SBP Leg edema P<0.05 % of patients Lercanidipine mgNifedipine GITS mgFelodipina mg mmHg % of patients

25 % patients with A.E.s P<0.001 % patients with A.E.s P<0.001 % patients with A.E.s P<0.001 Ankle edema Headache Flushing % patients withA.E.s P< Primary end-point Borghi C et al, Blood Pressure, 2003 Lercanidpine

26 Conclusions DHP-CCBs play a primary role in the treatment of HBP by reducing elevated BP values and the rate of major CV events. Lercanidipine is highly effective in reducing BP both in the general population and in subgroups of high risk patients (elderly, ISH, diabetic, etc.) The treatment with Lercanidipine is associated with an extensive target organ and metabolic protection in addition and beyond BP control. Its peculiar tolerability profile vs. other compounds of the same class, is an additional key feature that increases the clinical effectiveness of antihypertensive treatment and might reduce the costs of HBP. All these features may largely justify a primary role for lercanidipine for the management of the global cardiovascular risk in a large proportion of patients with HBP.


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