Ahmet KARAGÖZ, Özgül UÇAR, Sinan AYDOĞDU, Abdullah ÇELİK, Ayşe YÜKSEL

A different dihydropyridine calcium channel blocker in hypertensive patients who developed pedal edema on dihydropyridine calcium channel blocker therapy

Amaç. Dihidropiridin kalsiyum kanal blokerleri (KKB) etkinlikleri, metabolik nötraliteleri vedüşük yan etki profilleri nedeniyle hipertansiyon tedavisinde yaygın olarak tercih edilirler. Ancaktedavi sırasında ayak bileği ödemi gelişimi kullanımlarını kısıtlar. Bu çalışmanın amacıdihidropiridin KKB tedavisi sırasında ayak bileği ödemi gelişen hipertansif hastalarda farklı birdihidropiridin KKB ne geçilmesiyle ayak bileği ödemi gelişim oranının araştırılmasıdır. Yöntem.Dihidropiridin KKB tedavisi sırasında ayak bileği ödemi gelişen 58 hipertansif hasta (34 kadın, 24erkek, ortalama yaş 65,3±10,5) çalışmaya alındı. Bunlardan 40ında ayak bileği ödemine yol açanKKB amlodipin 10mg/gün, 14ünde amlodipin 5mg/gün ve 4ünde nifedipine GITS 30mg/gün idi.Ayak bileği ödemi yapan KKB kesilerek ödem kaybolduktan sonra farklı bir dihidropiridin KKB(felodipin ya da lasidipin) başlandı. Yeni başlanan KKB tedavisine hasta ayak bileği ödeminitolere ettikçe devam edildi. Bulgular. Bir yıllık takip dönemi sonunda 58 hastadan 44 (%75,9)tanesi (36 [%81.8] ödemsiz, 8 [%18.2] ödemli olarak) KKB tedavisine devam ediyordu. Felodipingrubunda 11 (%37,9) ve lasidipin grubunda 9 (%31,0) hastada ayak bileği ödemi gelişti. Felodipingrubunda 7, lasidipin grubunda 5 hastada ayak bileği ödemi geliştiği için tedavi kesildi. Felodipingrubunda bir hastada şiddetli başağrısı, lasidipin grubunda bir hastada ise flushing nedeniyletedavi sonlandırıldı. Sonuç. Dihidropiridin KKB tedavisi sırasında ayak bileği ödemi gelişenhipertansif hastalarda KKB tedavisini kesmek yerine başka gruptan bir dihidropiridin KKBalternatif olarak kullanılabilir.

Dihidropiridin grubu bir kalsiy um kanal blokeri tedavisi sırasında ayak bileği ödemi gelişen hip ertansif hastalarda f arklı bir dihidrop iridin kalsiy um kanal blokerinin kullanımı

Aim. Dihydropyridine calcium channel blockers (CCB) are widely preferred for the treatment ofhypertension for their efficacy, metabolic neutrality and low side effect profile. However pedaledema formation limits their usage. The aim of the present study is to evaluate the incidence ofpedal edema formation with a different dihydropyridine CCB in hypertensive patients whodeveloped pedal edema during a dihydropyridine CCB therapy. Method. Fifty-eight hypertensivepatients (34 female, 24 male, mean age: 65.3±10.5) in whom pedal edema developed duringtreatment with a dihydropyridine CCB (amlodipine 10mg/day in 40 patients, amlodipine 5mg/dayin 14 patients, nifedipine GITS 30mg/day in 4 patients) were enrolled. CCB which caused pedaledema was withdrawn and a different CCB (felodipine or lacidipine) were initiated after theresolution of the pedal edema. CCB therapy was continued as long as the patient tolerated pedaledema. Results. At the end of one year, 44 out of 58 patients (36 [81.8%] free of pedal edema, 8[19.2%] with pedal edema) continued CCB therapy. Eleven (37.9%) patients in the felodipinegroup and 9 (31.0%) patients in the lacidipine group developed pedal edema. In 7 patients infelodipine group and in 5 patients in the lacidipine group the study drug was withdrawn due topedal edema. In two patients, study drug was withdrawn due to intractable headache (felodipinegroup) or due to flushing (lacidipine group). Conclusion. A different group of dihydropyridineCCB be used as an alternative therapy for hypertension whenever pedal edema develops duringtreatment with a dihydropyridine CCB.

PDF

___

1. Messerli FH. Vasodilatory edema: A common side effect of antihypertensive therapy. Am J Hypertens 2001; 14: 978-9.
2. Leonetti G, Magnani B, Pessina AC, Rappelli A, Trimarco B, Zanchetti A; COHORT Study Group. Tolerability of long-term treatment with lercanidipine versus amlodipine and lacidipine in elderly hypertensives. Am J Hypertens 2002; 15: 932-40.
3. Makarounas-Kirchmann K, Glover-Koudounas S, Ferrari P. Results of a meta- analysis comparing the tolerability of lercanidipine and other dihydropyridine calcium channel blockers. Clin Ther 2009; 31: 1652-63.
4. Borghi C, Prandin MG, Dormi A, Ambrosioni E; Study Group of the Regional Unit of the Italian Society of Hypertension. Improved tolerability of the dihydropyridine calcium-channel antagonist lercanidipine: The Lercanidipine Challenge Trial. Blood Press Suppl 2003; 1: 14-21.
5. Weir MR, Rosenberger C, Fink JC. A pilot study to evaluate a water displacement technique to compare effects of diuretics and ACE inhibitors to alleviate lower extremity edema due to dihydropyridine calcium antagonists. Am J Hypertens 2001; 14: 963-8.
6. Weir MR, Ferdinand KC, Flack JM, Jamerson KA, Daley W, Zelenkofske S. A noninferiority comparison of valsartan/hydrochlorothiazide combination versus amlodipine in black hypertensives. Hypertension 2005; 46: 508-13.
7. Andresdottir MB, van Hamersvelt HW, van Helden MJ, van de Bosch WJ, Valk IM, Huysmans FT. Ankle edema formation during treatment with the calcium channel blockers lacidipine and amlodipine: A single-centre study. J Cardiovasc Pharmacol 2000; 35: S25-30.
8. Şahin M, Demir S, Aktürk S, Fedakar A, Alıcı G, Özkan B, Yazıcıoğlu MV, Cakalağaoğlu C, Yıldız M, Esen AM, Türkmen MM. Frequent change of intra- group drug effect on the blood pressure control and adaptation of therapy in hypertensive patients. Kosuyolu Kalp Derg 2013; 16: 7-12.
9. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HA, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Kjeldsen SE, Erdine S, Narkiewicz K, Kiowski W, Agabiti-Rosei E, Ambrosioni E, Cifkova R, Dominiczak A, Fagard R, Heagerty AM, Laurent S, Lindholm LH, Mancia G, Manolis A, Nilsson PM, Redon J, Schmieder RE, Struijker-Boudier HA, Viigimaa M, Filippatos G, Adamopoulos S, Agabiti-Rosei E, Ambrosioni E, Bertomeu V, Clement D, Erdine S, Farsang C, Gaita D, Kiowski W, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O'Brien E, Ponikowski P, Redon J, Ruschitzka F, Tamargo J, van Zwieten P, Viigimaa M, Waeber B, Williams B, Zamorano JL, The task force for the management of arterial hypertension of the European Society of Hypertension, The task force for the management of arterial hypertension of the European Society of Cardiology. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007; 28: 1462-536.
10. Cherubini A, Fabris F, Ferrari E, Cucinotta D, Antonelli Incalzi R, Senin U. Comparative effects of lercanidipine, lacidipine, and nifedipine gastrointestinal therapeutic system on blood pressure and heart rate in elderly hypertensive patients: The ELderly and LErcanidipine (ELLE) study. Arch Gerontol Geriatr 2003; 37: 203-12.
11. Barbagallo M, Barbagallo Sangiorgi G. Efficacy and tolerability of lercanidipine in monotherapy in elderly patients with isolated systolic hypertension. Aging (Milano) 2000; 12: 375-9.