Oedema formation with the vasodilators nifedipine and diazoxide

Hamersvelt, Henk W. van; Kloke, H. J.; Jong, Dirk J. de; Koene, R. A. P.; Huysmans, F.T.M.

doi:10.1097/00004872-199608000-00016

Cited by 50 publications

(41 citation statements)

References 14 publications

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“…[12][13][14] It has also been suggested that the Ca-antagonist-related oedema could be partly ascribed to interference by these drugs with the local vascular control (probably the myogenic component) that operates to protect dependent vascular regions from increased fluid filtration, 15,16 whereas sodium retention and activation of the renin-angiotensin system seem to play a minor role. 14,17 Most reports about the lower incidence of Caantagonist-induced ankle oedema with the addition of an ACE-I are generally based on a simple collection of reported side effects, that is, on subjective parameters rather than objective estimates of the magnitude of this effect. The present study was undertaken to evaluate objectively as to whether the addition of an ACE-I, benazepril, to the dihydropyridine Ca-antagonist amlodipine was able to attenuate ankle oedema formation in hypertensive patients treated for 4 weeks.…”

Section: Introductionmentioning

confidence: 99%

Effect of benazepril addition to amlodipine on ankle oedema and subcutaneous tissue pressure in hypertensive patients

et al. 2003

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The aim of this study was to evaluate the effect of benazepril addition to amlodipine antihypertensive treatment on ankle-foot volume (AFV) and pretibial subcutaneous tissue pressure (PSTP), two objective measures of ankle oedema. A total of 32 mild to moderate essential hypertensives (DBP490 and o110 mmHg), aged 30-70 years were studied. After a 4-week placebo period, they were randomized to amlodipine 5 mg o.d. or benazepril 10 mg o.d. or amlodipine 5 mg plus benazepril 10 mg o.d. for 4 weeks, according to a crossover design. At the end of the placebo period and of each active treatment period, blood pressure,AFV and PSTP were evaluated. AFV was measured using the principle of water displacement. PSTP was assessed using a system, the subcutaneous pretibial interstitial enviroment with a water manometer. Both amlodipine and benazepril monotherapy significantly reduced SBP (À18.2 7 4 and À17.8 7 4 mmHg, respectively, Po0.01 vs baseline) and DBP (À12.1 7 3 and À11.7 7 3 mmHg, respectively, Po0.01); the reduction was increased by the combination (À24.2 7 5 mmHg for SBP, Po0.001 and À16.8 7 4 mmHg for DBP, Po0.001). Amlodipine monotherapy significantly increased both AFV (+17.1%, Po0.001 vs baseline) and PSTP (+56.6%, Po0.001 vs baseline). As compared to amlodipine alone, the combination produced a less pronounced increase in AFV (+5.5%, Po0.05 vs baseline and Po0.01 vs amlodipine) and PSTP (+20.5%, Po0.05 vs baseline and Po0.01 vs amlodipine). Ankle oedema was clinically evident in 11 patients with amlodipine monotherapy and in three patients with the combination. These results suggest that ACE-inhibitors partially counteract the microcirculatory changes responsible for Ca-antagonists-induced oedema formation.

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Section: Introductionmentioning

confidence: 99%

Effect of benazepril addition to amlodipine on ankle oedema and subcutaneous tissue pressure in hypertensive patients

et al. 2003

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“…3 This troublesome side effect presents as leg and ankle swelling in the absence of sodium retention 4 or cardiac failure 1 and may reach the stage of pitting oedema, thereby requiring discontinuation of an otherwise highly effective antihypertensive therapy. This review will focus on the antagonism exerted by CCBs on cutaneous postural vasoconstriction, and the possible contribution of this pharmacological interference to the development of dependent oedema during treatment with CCBs.…”

Section: Introductionmentioning

confidence: 99%

Calcium channel blockers, postural vasoconstriction and dependent oedema in essential hypertension

2001

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Treatment with calcium channel blocker (CCB)s, dihydropyridines and others, is frequently complicated by dependent oedema in the absence of sodium retention or cardiac failure, a bothersome side effect of unclear aetiology. The present paper reviews our own and other work dealing with the antagonism exerted by such drugs on postural vasoconstriction, a mechanism triggered by limb venous congestion during orthostasis and controlled through a local sympathetic axo-axonic reflex and increased myogenic tone in response to changes in transmural pressure. By stabilising capillary pressure, postural vasoconstriction counteracts fluid

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“…Esta taxa é cerca de 5 a 6 vezes menor à incidência deste evento relatada na literatura, quando foi utilizada dose máxima de alguns antagonistas de cálcio, como amlodipina 10mg ou nifedipina 60mg onde a incidência de edema variou entre 30 a 45% da população tratada 28,29 . Além da baixa incidência, a intensidade do edema de membros inferiores em nossos pacientes foi leve a moderada e nenhum teve seu tratamento interrompido em decorrência desse evento.…”

Section: Discussionunclassified

“…Uma explicação plausível para a baixa incidência e intensidade do edema de membros inferiores observada com a manidipina é decorrente do fato desta droga dilatar o lado arterial e também o venoso do capilar periférico, diminuindo assim a pressão hidráulica do capilar, o que tem sido demonstrado por autores que mediram o volume e a pressão intersticial da perna de pacientes tratados com a manidipina ou amlodipina [28][29][30] . Concorre para facilitar a venodilatação capilar a ausência de estimulação simpática secundária 27 , uma vez que sabemos que as catecolaminas são potentes venoconstritores.…”

Section: Discussionunclassified

Manidipina no tratamento da hipertensão arterial essencial estágio I e II do paciente com sobrepeso ou obesidade andróide. Estudo multicêntrico brasileiro de eficácia, tolerabilidade e efeitos metabólicos

Júnior¹,

Ribeiro²

2001

Arq. Bras. Cardiol.

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Oedema formation with the vasodilators nifedipine and diazoxide

Cited by 50 publications

References 14 publications

Effect of benazepril addition to amlodipine on ankle oedema and subcutaneous tissue pressure in hypertensive patients

Effect of benazepril addition to amlodipine on ankle oedema and subcutaneous tissue pressure in hypertensive patients

Calcium channel blockers, postural vasoconstriction and dependent oedema in essential hypertension

Manidipina no tratamento da hipertensão arterial essencial estágio I e II do paciente com sobrepeso ou obesidade andróide. Estudo multicêntrico brasileiro de eficácia, tolerabilidade e efeitos metabólicos

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