Antihypertensive mechanism of action and binding sites of nitrendipine

Attenuation of the pressor response to tracheal intubation with oral nitrendipine

The effect of nitrendipine on the cardiovascular responses to tracheal intubation was studied in a placebo-controlled, randomised, double-blind trial. Thirty patients (ASA physical status 1) undergoing elective surgery received either 5 or 10 mg nitrendipine, or a placebo orally 3 h before induction of anaesthesia (n = 10 for each group). Anaesthesia was induced with sodium thiopentone 5 mg/kg i.v. and tracheal intubation was facilitated with vecuronium 0.2 mg/kg i.v. Patients receiving the placebo showed a significant increase in the mean arterial pressure and the rate-pressure product in response to tracheal intubation. These increases following intubation were reduced in nitrendipine-treated patients compared with the placebo group (P < 0.05). Oral administration of nitrendipine (5 or 10 mg, 3 h before induction of anaesthesia) was able to attenuate the hypertensive response to tracheal intubation in ASA 1 patients under light anaesthesia. We propose this pharmacological technique with supplementary doses of opioids and/or benzodiazepines for the management of patients with hypertension or coronary artery disease.

Nitrendipine: a new dihydropyridine calcium-channel antagonist for the treatment of hypertension

Nitrendipine, an investigational dihydropyridine calcium-channel antagonist for the treatment of hypertension, is reviewed. Clinical trials report efficacy equal to that of hydralazine, diuretics, beta-blockers, and other calcium-channel blockers such as nifedipine, verapamil, and isradipine. Nitrendipine has a favorable pharmacokinetic profile in that it is well absorbed and has a half-life long enough to allow once-daily administration in some patients. However, considerable variation observed with some pharmacokinetic parameters has consequently delayed marketing approval by the Food and Drug Administration. Adverse effects are generally mild and transient, and result from nitrendipine's vasodilatory properties. Nitrendipine may increase digoxin plasma concentrations in some patients, but this may not be clinically significant. Other studies are required to ascertain which drugs interact with nitrendipine. In summary, nitrendipine is safe and effective for treatment of hypertension, and because of its longer duration of action as well as lack of metabolic side effects, may provide an alternative to the present antihypertensive armamentarium.