Since the earlier review in Drugs substantial additional data have accumulated regarding the
antihypertensive efficacy of
isradipine in various clinical situations, as well as data on its clinical effects in
atherosclerosis. Recent therapeutic trials confirm that the efficacy of
isradipine in the treatment of patients with mainly mild to moderate
hypertension, when administered orally as a conventional or modified release preparation, is similar to that of titrated dosages of
amlodipine,
felodipine,
nifedipine,
diltiazem,
captopril,
methyldopa,
metoprolol,
prazosin and
hydrochlorothiazide. A further decrease in blood pressure can be expected when
isradipine is combined with another
antihypertensive drug in patients who have not responded adequately to monotherapy. Initial studies have shown that intravenous
isradipine is effective in controlling
hypertension following
coronary artery bypass graft surgery and that it appears useful in the treatment of intraoperative
hypertension and
hypertensive crisis, and in hypertensive disorders in pregnancy, when administered orally or intravenously. A large study, the Multicentre
Isradipine Diuretic Atherosclerosis Study (MIDAS), was designed to compare the efficacy of
isradipine and
hydrochlorothiazide in reducing the rate of progression of carotid artery wall thickness, measured by B-mode ultrasound, as a surrogate for early
atherosclerosis. Results indicated that wall thickness increased significantly less with
isradipine than
hydrochlorothiazide after 6 months of
therapy. Thereafter the rate of progression remained parallel for the remainder of the 3-year trial. The confirmation of its
antihypertensive efficacy, along with its favourable haemodynamic profile and reversal of
left ventricular hypertrophy, minimal effect on
glucose and lipid metabolism, preservation of quality of life and good tolerability, makes
isradipine a suitable
drug for the treatment of most patients with mild to moderate
hypertension.