Inzitari Domenico, Poggesi Anna
Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy.
Aging Clin Exp Res. 2005 Aug;17(4 Suppl):16-30.
The most frequent indication for Calcium Channel Blockers (CCBs) is their use as antihypertensive agents for primary or secondary stroke prevention. Hypertension contributes to virtually all mechanisms of stroke, of atherothrombotic, lacunar, cardioembolic and intraparenchymal hemorrhage types. In comparison with the rather univocal mechanisms underlying coronary artery or peripheral artery disease, the variable mechanisms of stroke are the main reason explaining not only the different impact of vascular risk factors, but also the different effects of drugs given for prevention. In an acute stroke setting, lowering blood pressure is potentially harmful, especially if it is carried out using short-acting dihydropyridine derivatives. Some CCBs, such as nicardipine, are preferred in certain conditions (including acute thrombolysis). In stroke, CCBs may also play a role as neuroprotectants. Then twofold effect--against vessel wall changes and as neuroprotectants (after ischemia or degenerative insults)--make this class of drugs of interest for their possible application in the setting of dementias, particularly that of vascular dementia. Some CCBs have been tested and are of benefit when used for preventing or treating cerebral vasospasm after subarachnoid hemorrhage. CCBs must be considered effective in preventing stroke in hypertensive patients. In comparison with other antihypertensive agents, their effects are similar to or even better than those exerted by other drugs. This may be due to the fact that stroke includes different types, with differing underlying pathophysiological mechanisms. The anti-atherosclerotic properties of CCBs may be useful in preventing the atherothrombotic type of stroke at the large pre-cerebral artery level. Dihydropyridinic derivatives may play a selective role in relation to small-vessel disease of the brain, which leads to multiple stroke-associated conditions, including lacunar infarct, intra-cerebral hemorrhage and subcortical vascular dementia. Oral nimodipine is recommended in the prevention/treatment of cerebral vasospasm following subarachnoid hemorrhage (SAH). CCBs, particularly nimodipine, may be of some benefit in vascular or mixed degenerative and vascular dementia or, taking into account subtypes, more selectively in subcortical vascular dementia. In this setting, CCBs may contribute toward reducing the risk of recurrent stroke in patients who are usually at high risk of recurrence.
钙通道阻滞剂（CCB）最常见的适应证是用作原发性或继发性卒中预防的抗高血压药物。高血压几乎与所有类型的卒中机制相关，包括动脉粥样硬化血栓形成性、腔隙性、心源性栓塞性和脑实质内出血性卒中。与冠状动脉疾病或外周动脉疾病相对明确的机制相比，卒中机制的多样性不仅是解释血管危险因素不同影响的主要原因，也是解释预防用药不同效果的主要原因。在急性卒中情况下，降低血压可能有害，尤其是使用短效二氢吡啶衍生物进行降压时。某些CCB，如尼卡地平，在某些情况下（包括急性溶栓）更为适用。在卒中治疗中，CCB还可能发挥神经保护作用。这种双重作用——对抗血管壁变化以及作为神经保护剂（在缺血或退行性损伤后）——使得这类药物因其在痴呆症，特别是血管性痴呆中的可能应用而受到关注。一些CCB已进行测试，在用于预防或治疗蛛网膜下腔出血后的脑血管痉挛时具有益处。CCB必须被视为对高血压患者预防卒中有效。与其他抗高血压药物相比，它们的效果与其他药物相似甚至更好。这可能是由于卒中包括不同类型，其潜在的病理生理机制也不同。CCB的抗动脉粥样硬化特性可能有助于在大脑前大动脉水平预防动脉粥样硬化血栓形成性卒中。二氢吡啶衍生物可能在与脑小血管疾病相关的方面发挥选择性作用，脑小血管疾病会导致多种与卒中相关的病症，包括腔隙性梗死、脑出血和皮质下血管性痴呆。推荐口服尼莫地平用于预防/治疗蛛网膜下腔出血（SAH）后的脑血管痉挛。CCB，尤其是尼莫地平，可能对血管性或混合性退行性和血管性痴呆有益，或者考虑到亚型，对皮质下血管性痴呆更具选择性益处。在这种情况下，CCB可能有助于降低通常具有高复发风险的患者再次发生卒中的风险。
