Vasodilatory edema: A common side effect of antihypertensive therapy
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Vasodilatory edema, a common adverse effect of antihypertensive therapy with vasodilators, is related to several mechanisms, including arteriolar dilatation (causing an increase in intracapillary pressure), stimulation of the renin-angiotensin-aldosterone system, and fluid volume retention. Vasodilatory edema is dosedependent and most common with direct arteriolar dilators such as minoxidil or hydralazine, and in decreasing order of frequency with the dihydropyridine calcium antagonists, α-blockers, antiadrenergic drugs, and nondihydropyridine calcium antagonists. Not all dihydropyridine calcium antagonists are created equal with regard to vasodilatory edema. At an equal antihypertensive efficacy, lercanidipine and lacidipine are associated with less vasodilatory edema than amlodipine and nifedipine. The addition of an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) to a dihydropyridine calcium antagonist significantly reduces vasodilatory edema. In contrast, the addition of a diuretic has little effect on vasodilatory edema. Thus, low-dose combination therapy (of a dihydropyridine calcium antagonist with either an ACE inhibitor or an ARB) may be preferred over high-dose monotherapy.
KeywordsCalcium Antagonist Amlodipine Felodipine Angiotensin Receptor Blocker Minoxidil
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References and Recommended Reading
- 2.Epstein M: Natriuretic effect. CV Drug Rev 1991, 9:399–413. An informative review on the natriuretic effects of calcium antagonists.Google Scholar
- 5.Fogari R, Malamani GD, Zoppi A, et al.: Comparative effect of lercanidipine and nifedipine gastrointestinal therapeutic system on ankle volume and subcutaneous interstitial pressure in hypertensive patients: a double-blind, randomized, parallel-group study. Curr Ther Res 2000, 61:851–862.Google Scholar
- 6.Leonetti G, Magnani B, Pessina AC, et al., on behalf of the COHORT Study Group: Tolerability of long-term treatment with lercanidipine vs. amlodipine and lacidipine in elderly hypertensives. Am J Hypertens 2002, in press. Results of the COHORT study of elderly hypertensive subjects.Google Scholar
- 8.Messerli FH, Oparil S, Feng Z: Comparison of efficacy and side effects of combination therapy of angiotensin-converting enzyme inhibitor (benazepril) with calcium antagonist (either nifedipine or amlodipine) versus high-dose calcium antagonist monotherapy for systemic hypertension. Am J Cardiol 2000, 86:1182–1187. Informative review of the efficacy of combination therapy for systemic hypertension.PubMedCrossRefGoogle Scholar
- 9.Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997, 157:2413–2446. Statement from the Joint Nation Committee supporting the use of combination therapy to minimize dose-dependent adverse effects.CrossRefGoogle Scholar