The central nervous system and effective antihypertensive effects of a calcium channel blocker.

Whether or not the central nervous system is involved in the genesis of hypertension in an individual patient, it becomes a major determinant of the responses to antihypertensive therapy once a treatment strategy is adopted. The major mechanisms through which the central nervous system influences blood pressure are sympathetic and parasympathetic nervous system activity and vasopressin release, either together or separately, but additional mechanisms may also contribute. When vasodilators are used, for example, the reactive increase in plasma catecholamines makes a substantial contribution to limiting the blood pressure fall. The sympathetic activation may lead to the reactive increase in plasma renin activity and sodium retention, which also plays an important role in limiting the antihypertensive action. Among newer agents, the effectiveness of calcium channel blockers could reflect a special action on the central nervous system that may contribute to reducing the reactive vasopressor responses. Treatment strategies that address the problem of the central nervous responses are more likely to be effective than approaches that avoid or ignore it.