Efficacy of an L- and N-type calcium channel blocker in hypertensive patients with neurovascular compression of the rostral ventrolateral medulla

Aota, Yasuko, et al. "Efficacy of an L-and N-type calcium channel blocker in hypertensive patients with neurovascular compression of the rostral ventrolateral medulla." Hypertension Research 32.8 (2009): 700-705. It has been previously shown in clinical studies that essential hypertension may be linked to neurovascular compression (NVC), and that NVC maybe be mediating hypertension through increased levels of sympathetic nerve activity. Neurovascular decompression studies have been shown to decrease blood pressure in patient with essential hypertension, but requires a rather intricate invasive surgery. The purpose of this study was to examine the effects of non-invasive, sympatholytic, L- and N-type calcium channel antagonist (Cilnidipine) for the use of a treatment for essential hypertension mediated by NVC. In this trial, 46 patient with essential hypertension (22 –NVC, 24 +NVC) were treated with Cilnidipine for 16 weeks, with clinical follow ups at 0, 8, and 16 weeks. At 8 and 16 weeks, systolic and diastolic blood pressure in both groups was significantly reduced from baseline levels. Correspondingly, systolic and diastolic pressures were significantly reduced in the +NVC group, compared to the –NVC group. To examine SNA, norepinephrine levels were taken at each time point, revealing that baseline levels of norephinephrine were significantly higher in the +NVC group than the –NVCs. That being said, at 16 there was a significant decrease in NE levels in the +NVC, but not –NVC group. With no difference in NE levels found between the groups. Finally, after measuring left ventricular mass index (LVMI) at each time point, it was observed that LVMI decreased in the +NVC, but not the –NVCs. Conclusively, this study was able to show the use of Cilnidipine by patients with EH mediated by NVC may be a non-invasive antihypertensive treatment. However, because Cilnidipine is not only an N-type calcium channel antagonist, but also an L-type vascular calcium channel antagonist more studies are being done to distinguish if the results seen were due to sympatholic or vascular effects. ~JI