High Cholesterol? Learn about treatments

Isradipine

Class: Dihydropyridines
VA Class: CV200
Chemical Name: 4-(4-Benzofurazanyl)-1,4-dihydro-2,6-dimethyl-3,5-pyridinedicarboxylic acid methyl 1-methylethyl ester
Molecular Formula: C19H21N3O5
CAS Number: 75695-93-1

Introduction

Calcium-channel blocking agent; dihydropyridine derivative.1 2 3 4 7

Uses for Isradipine

Hypertension

Management of hypertension (alone or in combination with other classes of antihypertensive agents).1 2 3 4 6 7 13 14 15 500

Calcium-channel blockers are recommended as one of several preferred agents for the initial management of hypertension; other options include ACE inhibitors, angiotensin II receptor antagonists, and thiazide diuretics.501 502 503 504 While there may be individual differences with respect to specific outcomes, these antihypertensive drug classes all produce comparable effects on overall mortality and cardiovascular, cerebrovascular, and renal outcomes.500 501 502 504 Individualize choice of therapy; consider patient characteristics (e.g., age, ethnicity/race, comorbidities, cardiovascular risk) as well as drug-related factors (e.g., ease of administration, availability, adverse effects, cost).500 501 502 503 504 515

Slideshow: Can Prescription Drugs Lead to Weight Gain?

Calcium-channel blockers may be preferred in hypertensive patients with certain coexisting conditions (e.g., ischemic heart disease)523 and in geriatric patients, including those with isolated systolic hypertension.502 510

Black hypertensive patients generally respond better to monotherapy with calcium-channel blockers or thiazide diuretics than to other antihypertensive drug classes (e.g., ACE inhibitors, angiotensin II receptor antagonists).500 501 504 However, diminished response to these other drug classes is largely eliminated when administered concomitantly with a calcium-channel blocker or thiazide diuretic.500 504

The optimum BP threshold for initiating antihypertensive drug therapy is controversial.501 504 505 506 507 508 515 523 530 Further study needed to determine optimum BP thresholds/goals; individualize treatment decisions.501 503 507 515 526 530

JNC 7 recommends initiation of drug therapy in all patients with uncomplicated hypertension and BP ≥140/90 mm Hg;500 JNC 8 panel recommends SBP threshold of 150 mm Hg for patients ≥60 years of age.501 Although many experts agree that SBP goal of <150 mm Hg may be appropriate for patients ≥80 years of age,502 504 505 530 application of this goal to those ≥60 years of age is controversial, especially for those at higher cardiovascular risk.501 502 505 506 508 511 515

In the past, initial antihypertensive drug therapy was recommended for patients with diabetes mellitus or chronic kidney disease who had BP ≥130/80 mm Hg;500 503 current hypertension management guidelines generally recommend a BP threshold of 140/90 mm Hg for these individuals (same as for the general population of patients without these conditions), although a goal of <130/80 mm Hg may still be considered.501 502 503 504 520 530 535 536 541

Use of currently available conventional dosage form for acute management of hypertensive crises not established.4 50

Isradipine has been used for rapid reduction of BP in pediatric patients 1–17 years of age with severe hypertension.76 83

Isradipine Dosage and Administration

General

BP Monitoring and Treatment Goals

  • Carefully monitor BP during initial titration or subsequent upward adjustment in dosage.500 501

  • When available, use evidence-based dosing information (i.e., dosages shown in randomized controlled trials to reduce complications of hypertension) to determine target dosages; target dosages usually can be achieved within 2–4 weeks but may take up to several months.501

  • If adequate BP response not achieved with a single antihypertensive agent, add a second drug with demonstrated benefit; if goal BP still not achieved with optimal dosages of 2 antihypertensive agents, add a third drug.501 May maximize dosage of the first drug before adding a second drug, or add a second drug before maximizing dosage of the initial drug.501

  • Consider initiating antihypertensive therapy with a combination of drugs if patient's BP exceeds goal BP by >20/10 mm Hg.500 501 503 504

  • Goal is to achieve and maintain optimal control of BP; individualize specific target BP based on consideration of multiple factors, including patient age and comorbidities, and currently available evidence from clinical studies.500 501 (See Hypertension under Uses.)

Administration

Oral Administration

Conventional Capsules

Administer orally twice daily without regard to meals.1 22

Reconstitution

Preparation of extemporaneous suspension containing isradipine 1 mg/mL: Open twenty-four 5-mg capsules and grind contents to a fine powder with a mortar and pestle;76 levigate with a small amount of glycerin to form a paste.81 Add simple syrup in increasing amounts while mixing thoroughly; transfer suspension to a graduated cylinder.81 Add any remaining drug in the mortar to the graduated container; the final volume of the suspension should be 120 mL.81 Transfer suspension to an amber bottle.81 Shake well before each use.81

Dosage

Pediatric Patients

Hypertension
Oral

Initially, 0.15–0.2 mg/kg daily given in 3–4 divided doses.76 Increase dosage as necessary up to a maximum dosage of 0.8 mg/kg (up to 20 mg) daily.76

Severe Hypertension
Rapid Reduction of BP
Oral

Children and adolescents 1–17 years of age: 0.05–0.1 mg/kg per dose.76

Adults

Hypertension
Oral

Initially, 1.25–2.5 mg twice daily 1 2 3 4 7 14 15 16 50 as monotherapy or when added to thiazide diuretic therapy.1

Full hypotensive effect may not be seen for 2–4 weeks.1 If BP control is inadequate after this period, increase dosage in increments of 5 mg daily at intervals of 2–4 weeks, up to a maximum of 20 mg daily, according to patient’s BP response.1 4 50 Some experts recommend usual dosage range of 2.5–10 mg daily.500

Dosages >10 mg daily usually do not result in further improvement in BP control and may increase risk of adverse effects.1 4 50

If intolerable adverse effects occur, consider dosage reduction; if adverse effects worsen or fail to resolve, may need to discontinue and switch to another antihypertensive drug class.501

Prescribing Limits

Pediatric Patients

Hypertension
Oral

Maximum 0.8 mg/kg (up to 20 mg) daily.76

Adults

Hypertension
Oral

Maximum 20 mg daily.1 4

Special Populations

Hepatic Impairment

Some clinicians recommend dosage modification (i.e., reduced dosage) and careful titration,3 21 but the manufacturer recommends usual initial adult dosage.1 4 7

Renal Impairment

Dosage modification not necessary.1 4 7

Geriatric Patients

Initial dosage modification not necessary,1 3 4 7 16 20 but slower dosage escalation recommended;3 20 BP may be adequately controlled with relatively low dosages and once-daily dosing.2 3 16

Cautions for Isradipine

Contraindications

  • Known hypersensitivity to isradipine or any ingredient in the formulation.1

Warnings/Precautions

General Precautions

Hypotension

Possible symptomatic hypotension.1 Carefully monitor BP, especially during therapy initiation or dosage increase.1

Heart Failure

May precipitate or worsen heart failure.1 16 18 Use with caution and titrate dosage carefully, especially in those receiving concomitant β-adrenergic blocking agents.1 16 18

Angina

Frequency, duration, and severity of angina may rarely increase during therapy.3 14 18

Specific Populations

Pregnancy

Category C.1

Lactation

Not known whether isradipine is distributed into milk; discontinue nursing or the drug.1

Pediatric Use

Safety and efficacy remain to be fully established in children;1 22 however, some experts have recommended dosages for hypertension based on current limited clinical experience.76

Common Adverse Effects

Headache, dizziness, peripheral edema, palpitation, tachycardia, flushing, chest pain.1 2 3 4 10 11 13 14 15 16 17 18 19 20 21 22 23 24 25 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 51 52 53

Interactions for Isradipine

Appears to be metabolized by CYP3A4.1

Specific Drugs

Drug

Interaction

Comments

Cimetidine

Increased peak plasma concentrations and AUC of isradipine1

Monitor carefully; reduction of isradipine dosage may be required1

Digoxin

Pharmacokinetic interaction unlikely1

Fentanyl

Possible severe hypotension during fentanyl anesthesia with concomitant use of a β- blocker and a calcium channel blocker1

Increase volume of circulating fluids if hypotension occurs1

Hydrochlorothiazide

Pharmacokinetic interaction unlikely1

Nitroglycerin

Pharmacokinetic interaction unlikely1

Propranolol

Increased rate of absorption, AUC, and peak plasma concentrations of propranolol observed with single doses; no substantial effect on either drug under steady-state conditions1

Rifampin

Increased isradipine metabolism and clearance; reduction of isradipine concentrations to below detectable levels1

Isradipine concentrations and therapeutic effects will be markedly reduced or abolished with concomitant use1

Warfarin

Pharmacokinetic or pharmacodynamic interaction unlikely

Isradipine Pharmacokinetics

Absorption

Bioavailability

90–95% absorbed following oral administration, with peak plasma isradipine concentrations attained in about 1.5 hours.1

Bioavailability is approximately 15–24% due to first-pass metabolism.1

Onset

After a single dose, reduction in supine and standing BP occurs within 2–3 hours.1

Duration

Effects persist for >12 hours after administration.1

Food

Food decreases time to peak plasma concentration by about 1 hour.1

Special Populations

In patients with hepatic impairment, peak plasma concentration and AUC are increased by 32 and 52%, respectively.1

In patients with mild renal impairment (Clcr 30–80 mL/min), AUC is increased by 45%; however, in patients with severe renal failure (Clcr <10 mL/min) who have been on hemodialysis, AUC is decreased by 20–50%.1

In geriatric patients, peak plasma concentration and AUC are increased by 13 and 40%, respectively.1

Distribution

Extent

It is not known whether isradipine is distributed into milk.1

Plasma Protein Binding

95%.1

Elimination

Metabolism

Completely metabolized in the liver, apparently by CYP3A4, to inactive metabolites.1

Elimination Route

Excreted in urine (60–65%) and feces (25–30%).1

Half-life

Biphasic; initial half-life is 1.5–2 hours and terminal elimination half-life is approximately 8 hours.1

Stability

Storage

Oral

Conventional Capsules

Tight, light-resistant containers at 20–25°C.82

Extemporaneous Suspension

Isradipine 1 mg/mL in simple syrup (see Reconstitution under Dosage and Administration): Stable for 35 days when refrigerated.81

Actions

  • Inhibits transmembrane influx of extracellular calcium ions across the membranes of myocardial cells and vascular smooth muscle cells, without changing serum calcium concentrations.1

  • Peripheral arterial vasodilator; acts directly on vascular smooth muscle causing reduction in peripheral vascular resistance (afterload) and BP.1

Advice to Patients

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.1

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of informing patients of other important precautionary information.1 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Isradipine

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

2.5 mg*

Isradipine Capsules

5 mg*

Isradipine Capsules

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2015. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

DynaCirc CR 10MG 24-hr Tablets (GLAXO SMITH KLINE): 30/$129.99 or 90/$369.96

DynaCirc CR 5MG 24-hr Tablets (GLAXO SMITH KLINE): 30/$83.99 or 90/$232.51

Isradipine 2.5MG Capsules (WATSON LABS): 60/$79.99 or 180/$211.97

AHFS DI Essentials. © Copyright, 2004-2015, Selected Revisions January 26, 2015. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

1. Reliant Pharmaceuticals. DynaCirc (isradipine) capsules prescribing information. Liberty Corner, NJ; 2003 Oct.

2. Lopez LM, Santiago TM. Isradipine—another calcium-channel blocker for the treatment of hypertension and angina. Ann Pharmacother. 1992; 26:789-99. [IDIS 298260] [PubMed 1535246]

3. Fitton A, Benfield P. Isradipine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in cardiovascular disease. Drugs. 1990; 40:31-74. [PubMed 2143980]

4. Walton T, Symes LR. Felodipine and isradipine: new calcium-channel blocking agents for the treatment of hypertension. Clin Pharm. 1993; 12:261-75. [IDIS 311530] [PubMed 8458178]

6. Prisant LM, Carr AA, Nelson EB et al. Isradipine vs propranolol in hydrochlorothiazide-treated hypertensives: a multicenter evaluation. Arch Intern Med. 1989; 149:2453-7. [IDIS 260612] [PubMed 2530945]

7. Anon. Isradipine for hypertension. Med Lett Drugs Ther. 1991; 33:51-4. [PubMed 1827655]

8. Alderman MH. Which antihypertensive drugs first—and why! JAMA. 1992; 267:2786-7. Editorial.

9. Weber MA, Laragh JH. Hypertension: steps forward and steps backward: the Joint National Committee fifth report. Arch Intern Med. 1993; 153:149-52. [PubMed 8422205]

10. Dahlof B. Hemodynamic response, safety, and efficacy of isradipine in the treatment of essential hypertension. Am J Med. 1988; 86(Suppl 4A):19-26.

11. Kirkendall WM. Comparative assessment of first-line agents for treatment of hypertension. Am J Med. 1988; 84(Suppl 3B):32-41. [IDIS 243146] [PubMed 3260071]

12. Rauramaa R, Taskinen E, Seppanen K et al. Effects of calcium antagonist treatment on blood pressure, lipoproteins and prostaglandins. Am J Med. 1988; 84(Suppl 3B):93-6.

13. Cocco G, Alfiero R, Boxho G et al. Multicenter evaluation of the safety and efficacy of isradipine in hypertension. The Italian-Belgian Isradipine Study Group. Am J Med. 1989; 86(Suppl 4A):94-7.

14. Sundstedt CD, Ruegg PC, Keller A et al. A multicenter evaluation of safety, tolerability, and efficacy of isradipine in the treatment of essential hypertension. Am J Med. 1989; 86(Suppl 4A):98-102. [IDIS 254264] [PubMed 2523665]

15. De Keyser P, Bouve J, Clement D et al. Isradipine in essential hypertension: the Belgian general practitioners’ study. Am J Med. 1989; 86(Suppl 4A):103-9. [PubMed 2565687]

16. Anderton JL, Adams RM, Chowdary KVG et al. Evaluation of the safety and efficacy of isradipine in elderly patients with essential hypertension. The British Isradipine Hypertension Group. Am J Med. 1989; 86(Suppl 4A):110-14.

17. O’Rourke MF, Balasubramaniam A, Anavekar S et al. A multicenter evaluation of the safety and efficacy of isradipine and atenolol in the treatment of hypertension. Isradipine in Hypertension Study Group. Am J Med. 1989; 86(Suppl 4A):119-23.

18. Ruegg PC, Nelson DJ. Safety and efficacy of isradipine, alone and in combination, in the treatment of angina pectoris. Am J Med. 1989; 86(Suppl 4A):70-4. [IDIS 254258] [PubMed 2565689]

19. McGrath BP, Newman R, Older P. Hemodynamic study of short- and long-term isradipine treatment in patients with chronic ischemic congestive heart failure. Am J Med. 1989; 86(Suppl 4A):75-80. [IDIS 254259] [PubMed 2523660]

20. Chellingsworth MC, Willis JV, Jack DB et al. Pharmacokinetics and pharmacodynamics of isradipine (PN 200-110) in young and elderly patients. Am J Med. 1988; 84(Suppl 3B):72-9.

21. Cotting J, Reichen J, Kutz K et al. Pharmacokinetics of isradipine in patients with chronic liver disease. Eur J Clin Pharmacol. 1990; 38:599-603. [IDIS 268333] [PubMed 2142648]

22. Sandoz Pharmaceuticals Corp, East Hanover, NJ: Personal communication.

23. Glasser SP, Clark PI, Lipicky RJ et al. Exposing patients with chronic, stable, exertional angina to placebo periods in drug trials. JAMA. 1991; 265:1550-4. [PubMed 1671885]

24. National Heart, Lung, and Blood Institute. NHLBI panel reviews safety of calcium channel blockers. Rockville, MD; 1995 Aug 31. Press release.

25. National Heart, Lung, and Blood Institute. New analysis regarding the safety of calcium-channel blockers: a statement for health professionals from the National Heart, Lung, and Blood Institute. Rockville, MD; 1995 Sep 1.

26. Anon. NHLBI panel stands by JNC V in response to Circulation CCB article; AIM report supports use of beta blockers for prevention of sudden cardiac death. F-D-C Rep. 1995; 57(Sep 4):3- 4.

27. American Heart Association. Public advisory statement on calcium channel blocker drugs. Dallas, TX; 1995 Aug 28.

28. Psaty BM, Heckbert SR, Koepsell TD et al. The risk of myocardial infarction associated with antihypertensive drug therapies. JAMA. 1995; 274:620-5. [IDIS 352203] [PubMed 7637142]

29. Psaty BM, Heckbert SR, Koepsell TD et al. The risk of incident myocardial infarction associated with anti-hypertensive drug therapies. Circulation. 1995; 91:925.

30. Buring JE, Glynn RJ, Hennekens CH. Calcium channel blockers and myocardial infarction: a hypothesis formulated but not yet tested. JAMA. 1995; 274:654- 5. [IDIS 352205] [PubMed 7637148]

31. Furberg CD, Psaty BM, Meyer JV. Nifedipine: dose-related increase in mortality in patients with coronary heart disease. Circulation. 1995; 92:1326-31. [IDIS 353358] [PubMed 7648682]

32. Opie LH, Messerli FH. Nifedipine and mortality: grave defects in the dossier. Circulation. 1995; 92:1068-73. [IDIS 353353] [PubMed 7648646]

33. Kloner RA. Nifedipine in ischemic heart disease. Circulation. 1995; 92:1074-8. [IDIS 353354] [PubMed 7648647]

34. Yusuf S. Calcium antagonists in coronary artery disease and hypertension: time for reevaluation? Circulation. 1995; 92:1079-82. Editorial.

35. Lenfant C. The calcium channel blocker scare: lessons for the future. Circulation. 1995; 91:2855-6. [PubMed 7796490]

36. Habib GB. Are calcium antagonists harmful in hypertensive patients? Distinguishing hype from reality. Chest. 1995; 108:3-5. [IDIS 351406] [PubMed 7606987]

37. Horton R. Spinning the risks and benefits of calcium antagonists. Lancet. 1995; 346:586- 7. [IDIS 353102] [PubMed 7650997]

38. Yusuf S, Held P, Furberg C. Update of effects of calcium antagonists in myocardial infarction or angina in light of the Second Danish Verapamil Infarction Trial (DAVIT-II) and other recent studies. Am J Cardiol. 1991; 67:1295-7. [IDIS 284079] [PubMed 2035457]

39. Egstrup K, Andersen PE Jr. Transient myocardial ischemia during nifedipine therapy in stable angina pectoris, and its relation to coronary collateral flow and comparison with metoprolol. Am J Cardiol. 1993; 71:177- 83. [IDIS 308552] [PubMed 8421980]

40. Wagenknecht LE, Furberg CD, Hammon JW et al. Surgical bleeding: unexpected effect of a calcium antagonist. BMJ. 1995; 310:776-7. [IDIS 345035] [PubMed 7711582]

41. Miles Inc. American Heart Association, Dr. Psalty and Miles Inc. release statements qualifying possible risks of calcium channel blockers. West Haven, CT; 1995 Mar 15. Press release.

42. Dear healthcare professional letter regarding calcium-channel blockers and increased risk of heart attack. Chicago:Searle. 1995 Mar 17.

43. McClellan K. Unexpected results from MIDAS in atherosclerosis. Inpharma Wkly. 1994; Apr 9:4.

44. Anon. Groups act to dispel concerns about calcium-channel blockers. Am J Health-Syst Pharm. 1995; 52:1154, 1158. [PubMed 7656105]

45. Waters D. Proischemic complications of dihydropyridine calcium channel blockers. Circulation. 1991; 84:2598-600. [IDIS 295953] [PubMed 1959210]

46. Messerli FH. Case-control study, meta-analysis, and bouillabaisse: putting the calcium antagonist scare into context. Ann Intern Med. 1995; 123:888-9. [IDIS 356631] [PubMed 7486476]

47. Reviewers’ comments (personal observations).

48. Pratt Pharmacueticals. Procardia (nifedipine) capsules prescribing information (dated 1993 Feb). In: Physicians’ desk reference. 49th ed. Montvale, NJ: Medical Economics Company Inc; 1995:1906-7.

49. Held PH, Yusuf S, Furberg CD. Calcium channel blockers in acute myocardial infarction and unstable angina: an overview. BMJ. 1989; 299:1187-92. [IDIS 260789] [PubMed 2513047]

50. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Bethesda, MD: National Institutes of Health; 1997 Nov. (NIH publication No. 98-4080.)

51. Kaplan NM. Choice of initial therapy for hypertension. JAMA. 1996; 275:1577-80. [IDIS 365188] [PubMed 8622249]

52. Psaty BM, Smith NL, Siscovich DS et al. Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and meta-analysis. JAMA. 1997; 277:739-45. [IDIS 380501] [PubMed 9042847]

53. American College of Cardiology and American Heart Association. ACC/AHA guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol. 1996; 28:1328-428. [IDIS 376249] [PubMed 8890834]

55. Izzo JL, Levy D, Black HR. Importance of systolic blood pressure in older Americans. Hypertension. 2000; 35:1021-4. [PubMed 10818056]

56. Frohlich ED. Recognition of systolic hypertension for hypertension. Hypertension. 2000; 35:1019-20. [PubMed 10818055]

57. Bakris GL, Williams M, Dworkin L et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. Am J Kidney Dis. 2000; 36:646-61. [IDIS 452007] [PubMed 10977801]

58. Associated Press (American Diabetes Association). Diabetics urged: drop blood pressure. Chicago, IL; 2000 Aug 29. Press Release from web site.

60. Appel LJ. The verdict from ALLHAT—thiazide diuretics are the preferred initial therapy for hypertension. JAMA. 2002; 288:3039-60. [IDIS 490723] [PubMed 12479770]

61. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-riskhypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002; 288:2981-97. [IDIS 490721] [PubMed 12479763]

62. Velussi M, Brocco E, Frigato F et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes. 1996; 45:216-22. [IDIS 362953] [PubMed 8549868]

63. Estacio RO, Jeffers BW, Hiatt WR et al. The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. N Engl J Med. 1998; 338:645-52. [IDIS 400553] [PubMed 9486993]

64. Pahor M, Psaty BM, Furberg CD. Treatment of hypertensive patients with diabetes. Lancet. 1998; 351:689-90. [IDIS 409001] [PubMed 9504510]

65. Tatti P, Pahor M, Byington RP et al. Outcome results of the Fosinopril versus Amlodipine Cardiovascular Events randomized Trial (FACET) in patients

66. Byington RP, Craven TE, Furberg CD et al. Isradipine, raised glycosylated haemoglobin, and risk of cardiovascular events. Lancet. 1997; 350:1075-6. [IDIS 393279] [PubMed 10213554]

67. Alderman M, Madhavan S, Cohen H. Calcium antagonists and cardiovascular events in patients with hypertension and diabetes. Lancet. 1998; 351:216-7. [IDIS 398935] [PubMed 9449897]

68. Josefson D. Infarction risk found with calcium channel blocker. BMJ. 1998; 316:797.

69. Cutler JA. Calcium-channel blockers for hypertension—uncertainty continues. N Engl J Med. 1998; 338:679-81. [IDIS 400554] [PubMed 9486999]

70. Bayer, West Haven, CT: Personal communication on amlodipine.

71. Bakris GL, Copley JB, Vicknair N et al. Calcium channel blockers versus other antihypertensive therapies on progression of NIDDM associated nephropathy. Kidney Int. 1996; 50:1641-50. [PubMed 8914031]

74. Kaplan NM. The meaning of ALLHAT. J Hypertens. 2003; 21:233-4. [PubMed 12569243]

76. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004; 114(Suppl 2):555-76. [PubMed 15286277]

77. Wright JT, Dunn JK, Cutler JA et al. Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA. 2005; 293:1595-607. [IDIS 531054] [PubMed 15811979]

78. Neaton JD, Kuller LH. Diuretics are color blind. JAMA. 2005; 293:1663-6. [IDIS 531056] [PubMed 15811986]

79. Leenen FHH, Nwachuku CE, Black HR et al. Clinical events in high-risk hypertensive patients randomly assigned to calcium-channel blocker versus angiotensin-converting enzyme inhibitor in the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial. Hypertension. 2006; 48:374-84. [PubMed 16864749]

80. Messerli FH, Staessen JA. Amlodipine better than lisinopril: how one randomized clinical trial ended fallacies from observational studies? Hypertension. 2006; 48:359-61. Editorial.

81. (Isradipine Suspension 1 mg/mL) In: Jew RK, Mullen RJ, Soo-Hoo W. Extemporaneous formulations. Bethesda, MD; American Society of Health-System Pharmacists, Inc: 2003:(page 32).

82. Cobalt Laboratories. Isradipine capsules prescribing information. Bonita Springs, FL; 2008 May.

83. Miyashita Y, Peterson D, Rees JM et al. Isradipine for treatment of acute hypertension in hospitalized children and adolescents. J Clin Hypertens (Greenwich). 2010; 12:850-5. [PubMed 21054771]

500. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Bethesda, MD: National Institutes of Health; 2004 Aug. (NIH publication No. 04-5230.)

501. James PA, Oparil S, Carter BL et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311:507-20. [PubMed 24352797]

502. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013; 31:1281-357. [PubMed 23817082]

503. Go AS, Bauman MA, Coleman King SM et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. 2014; 63:878-85. [PubMed 24243703]

504. Weber MA, Schiffrin EL, White WB et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens (Greenwich). 2014; 16:14-26. [PubMed 24341872]

505. Wright JT, Fine LJ, Lackland DT et al. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view. Ann Intern Med. 2014; 160:499-503. [PubMed 24424788]

506. Mitka M. Groups spar over new hypertension guidelines. JAMA. 2014; 311:663-4. [PubMed 24549531]

507. Peterson ED, Gaziano JM, Greenland P. Recommendations for treating hypertension: what are the right goals and purposes?. JAMA. 2014; 311:474-6. [PubMed 24352710]

508. Bauchner H, Fontanarosa PB, Golub RM. Updated guidelines for management of high blood pressure: recommendations, review, and responsibility. JAMA. 2014; 311:477-8. [PubMed 24352759]

510. Staessen JA, Fagard R, Thijs L et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997; 350:757-64. [PubMed 9297994]

511. JATOS Study Group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res. 2008; 31:2115-27. [PubMed 19139601]

515. Thomas G, Shishehbor M, Brill D et al. New hypertension guidelines: one size fits most?. Cleve Clin J Med. 2014; 81:178-88. [PubMed 24591473]

516. Wright JT, Bakris G, Greene T et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002; 288:2421-31. [PubMed 12435255]

520. American Diabetes Association. Standards of medical care in diabetes--2014. Diabetes Care. 2014; 37 Suppl 1:S14-80. [PubMed 24357209]

522. Patel A, ADVANCE Collaborative Group, MacMahon S et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet. 2007; 370:829-40. [PubMed 17765963]

523. Fihn SD, Gardin JM, Abrams J et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012; 126:e354-471. [PubMed 23166211]

524. WRITING COMMITTEE MEMBERS, Yancy CW, Jessup M et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013; 128:e240-327. [PubMed 23741058]

525. Smith SC, Benjamin EJ, Bonow RO et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011; 124:2458-73. [PubMed 22052934]

526. Kernan WN, Ovbiagele B, Black HR et al. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2014; :. [PubMed 24788967]

527. O'Gara PT, Kushner FG, Ascheim DD et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 127:e362-425. [PubMed 23247304]

530. Myers MG, Tobe SW. A Canadian perspective on the Eighth Joint National Committee (JNC 8) hypertension guidelines. J Clin Hypertens (Greenwich). 2014; 16:246-8. [PubMed 24641124]

535. Taler SJ, Agarwal R, Bakris GL et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for management of blood pressure in CKD. Am J Kidney Dis. 2013; 62:201-13. [PubMed 23684145]

536. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl. 2012: 2: 337-414.

541. Perk J, De Backer G, Gohlke H et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012; 33:1635-701. [PubMed 22555213]

Hide
(web3)