Vaskulárna medicína 2/2013

Amlodipin and central systolic blood pressure in hypertensives

Amlodipin is an antihypertensive drug belonging into the group of dihydropyridine derivatives of L-type calcium channel blockers with pronounced selective vasodilatatory effect. It has advantageous pharmacodynamic and pharmacokinetic properties, an exceptionally long half-life of excretion (30 to 50 hours) with achieving the maximal hemodynamic effect after 7 days from starting the therapy. Smooth muscle relaxation and remodelling of resistent arteriols decreases not only brachial blood pressure, but also decreases the stiffness of arteries and aortic pulse wave velocity and thus the central systolic blood pressure. This effect is caused by lowering the amplitudes of initial pulse pressure waves generated during the systole of left ventricle and also by lowering the amplitudes of reflected pressure waves from the periphery. This increases the effectivity of left ventricular work, improves its blood supply during the diastole and contributes to the prevention of cardiovascular events. The favorable contribution of amlodipine to the treatment of hypertension results not only from the lowering of blood pressure per se, but also from the supression of blood pressure variability which is known as another parameter increasing the cardiovascular risk. Amlodipine, influencing also nondihydropyridine calcium channels, has vasculoprotective effects mediated through antiprolipherative effect on vascular smooth muscle and extracellular matrix, has antiatherogenic and antioxidative effects in the vessel wall. Its vasodilatative effect is amplified by stimulation of NO release from endothel. Favorable effects non-related to the L-type voltage-dependant calcium channels are called as pleiotropic effects of amlodipine, adding more benefits to its advantageuos clinical profile. The combination of amlodipine with angiotensine converting enzyme inhibitors (ACEI) or angiotensine II receptor blockers (ARB) is considered as the most effective antihypertensive therapy in reducing the cardiovascular risk.

Keywords: amlodipine, aortic pulse wave velocity, aortic stiffness, central systolic blood pressure, antihypertensive therapy, cardiovascular risk.