Correlation between predicted theoretical mechanistic biochemistry (TMB) data and therapeutic effects in the management of vascular disorders with calcium channel blockers.

Theoretical mechanistic biochemistry (TMB) analysis was used to predict the therapeutic effects of calcium channel blockers in the drug management of hypertension, cerebrovascular disorders (CVD) and coronary artery disease (CAD). This analysis was extended to acetylsalicylic acid (aspirin) a non-calcium channel blocker which is nevertheless commonly used in the management of the same disorders. TMB data have suggested nisoldipine, nicardipine and nimodipine as agents of choice in the management of cerebrovascular disease, e.g. in transient ischemic attacks (TIAs). The same agents were found preferable in the management of coronary artery disease. It is noteworthy that atherosclerosis and vascular spasm are common pathogenic events in both conditions. For lowering blood pressure, without compromising cerebral and coronary blood flows TMB data suggested nisoldipine, nicardipine, nimodipine and nifedipine in that preferential order. For tissue selectivity, TMB data have identified nisoldipine, nicardipine, nifedipine, nimodipine and nitrendipine for vascular tissue and that verapamil, diltiazem and aspirin have little or no tissue selectivity. TMB data have gone further to suggest a combination of nicardipine, nisoldipine or nimodipine with beta-blockers in order to reduce the frequently uncomfortable reflex tachycardia often induced by some calcium channel blockers. By and large, TMB predicted data have been found to correlate reasonably well with clinically observed and reported therapeutic effects of calcium channel blockers. Their consistency in the management of hypertension, cerebrovascular disease and coronary artery disease is apparent in this study.