Calcium channel blockers and stroke prevention

Abstract

Stroke is a major cause of morbidity, mortality, and disability. A large proportion of stroke burden is nowadays considered preventable, and in this sense, stroke prevention, either primary or secondary prevention, plays an important role. Among the modifiable risk factors for stroke, hypertension is the most important one, and this fact is mainly explained by its implication in virtually all the mechanisms by which stroke is produced. It is nowadays conclusively evidenced that lowering blood pressure reduces the risk of cardiovascular outcomes, including stroke, irrespective of age or individual risk factor profile. Among the different antihypertensive drugs, from the last systematic reviews, it is apparent that calcium channel blockers (CCBs) have a greater effect compared to other classes of drugs in reducing the risk of stroke. The chapter summarizes the role of CCBs in the field of stroke prevention analyzing: (1) results of the main randomized clinical trials on hypertensive patients testing the efficacy of a CCB vs. other classes of drugs, and reviewing the evidence brought by reviews and meta-analyses; (2) the possible pleiotropic actions and anti-atherosclerotic mechanisms related to CCBs; (3) the role of CCBs in the field of vascular dementia and vascular cognitive impairment.