ANTIHYPERTENSIVE THERAPY WITH THE CALCIUM-CHANNEL BLOCKER ISRADIPINE - AN APPROPRIATE CHOICE FOR THE DIABETIC PATIENT WITH HYPERTENSION - AREVIEW

Treatment of hypertension in diabetic patients or patients with impair ed glucose tolerance requires a specialized approach. Such hypertensiv e, glucose-impaired patients often have multiple medical problems, pos sibly from common causes, such as renal impairment, atherosclerosis, e lectrolyte disturbance, neuropathy, or cardiac dysfunction. Antihypert ensive therapy in these high-risk, medically compromised patients must reduce blood pressure while having a beneficial or neutral effect on the diabetic state and other coexisting diseases with possible catastr ophic end points. Isradipine is a second-generation, dihydropyridine-t ype calcium channel blocker shown to be efficacious, safe, and well to lerated in the treatment of diabetic patients with hypertension. In cl inical trials of patients with insulin-dependent or non-insulin-depend ent diabetes mellitus, monotherapy with isradipine normalized blood pr essure in a majority of patients with minimal adverse reactions and no clinically significant alteration of heart rate. More importantly, is radipine had either a neutral or a beneficial effect on glucose homeos tasis and lipid metabolism. In studies of nondiabetic patients with hy pertension, isradipine has been shown to facilitate renal function by decreasing renal vascular resistance, increasing renal plasma flow, an d maintaining or improving glomerular filtration rate and filtration f raction. These physiological effects may benefit patients with coexist ing diabetes and hypertension, in whom end-stage renal disease is a co mmon consequence. Studies to evaluate the effects of isradipine on a n umber of parameters or conditions important to the diabetic patient, i ncluding serum lipids, atherosclerosis, and proteinuria, are currently in progress.