ISRADIPINE - AN UPDATE OF ITS PHARMACODYNAMIC AND PHARMACOKINETIC PROPERTIES AND THERAPEUTIC EFFICACY IN THE TREATMENT OF MILD-TO-MODERATE HYPERTENSION

Since the earlier review in Drugs substantial additional data have acc umulated regarding the antihypertensive efficacy of isradipine in vari ous clinical situations, as well as data on its clinical effects in at herosclerosis. Recent therapeutic trials confirm that the efficacy of isradipine in the treatment of patients with mainly mild to moderate h ypertension, when administered orally as a conventional or modified re lease preparation, is similar to that of titrated dosages of amlodipin e, felodipine, nifedipine, diltiazem, captopril, methyldopa, metoprolo l, prazosin and hydrochlorothiazide. A further decrease in blood press ure can be expected when isradipine is combined with another antihyper tensive drug in patients who have not responded adequately to monother apy. Initial studies have shown that intravenous isradipine is effecti ve in controlling hypertension following coronary artery bypass graft surgery and that it appears useful in the treatment of intraoperative hypertension and hypertensive crisis, and in hypertensive disorders in pregnancy, when administered orally or intravenously. A large study, the Multicentre Isradipine Diuretic Atherosclerosis Study (MIDAS), was designed to compare the efficacy of isradipine and hydrochlorothiazid e in reducing the rate of progression of carotid artery wall thickness , measured by B-mode ultrasound, as a surrogate for early atherosclero sis. Results indicated that wall thickness increased significantly les s with isradipine than hydrochlorothiazide after 6 months of therapy. Thereafter the rate of progression remained parallel for the remainder of the 3-year trial. The confirmation of its antihypertensive efficac y along with its favourable haemodynamic profile and reversal of left ventricular hypertrophy, minimal effect on glucose and lipid metabolis m, preservation of quality of life and good tolerability makes isradip ine a suitable drug for the treatment of most patients with mild to mo derate hypertension.