Nicardipine is a second generation
dihydropyridine calcium antagonist which selectively inhibits vascular smooth muscle contraction. In elderly patients, the
drug has demonstrated clinical efficacy in the management of
hypertension,
angina pectoris and ischaemia-related
cerebrovascular disease. In particular,
nicardipine effectively controls blood pressure in elderly hypertensive patients with or without coexistent disease. In noncomparative trials, a regimen containing
nicardipine has been associated with an improvement of symptoms in hypertensive patients with concurrent coronary artery, cerebrovascular or
peripheral vascular disease, while in essentially 'healthy' elderly hypertensive patients,
nicardipine monotherapy has resulted in improved indices of mobility and cognitive function. As yet, however, there is no evidence that
nicardipine (and/or other
calcium channel antagonists) decreases cardiovascular morbidity and mortality in elderly patients, as has been demonstrated for more established
antihypertensive therapies, namely
diuretics and/or beta-blockers. The pharmacokinetic properties of
nicardipine in elderly hypertensive patients appear to be similar to those in younger patients. The main adverse events associated with
nicardipine in the elderly are related to the
vasodilator properties of the
drug and include pedal oedema,
headache and
flushing. However, the
drug does not exacerbate spontaneous
postural hypotension in the elderly, nor does it adversely affect the
coronary artery disease risk profile, even in patients with type II
diabetes mellitus. In summary, widespread clinical experience in the elderly indicates that
nicardipine monotherapy or a regimen containing
nicardipine is useful for the treatment of
hypertension, particularly in patients with coexistent coronary artery, cerebrovascular or
peripheral vascular disease.
Nicardipine monotherapy has also demonstrated efficacy in
angina pectoris and shown promise in the management of ischaemia-related
cerebrovascular diseases, notably subarachnoid haemorrhage.