scholarly journals Conflicts over calcium and the treatment of covid-19

2020 ◽  
Author(s):  
Bernard Crespi ◽  
Joe Alcock
Keyword(s):  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Clinical Studies ◽  
Calcium Metabolism ◽  
Host Defence ◽  
Channel Blockers ◽  
Considerable Evidence ◽  
Antiviral Effects ◽  
Infected Cells ◽  
Serum Ionized Calcium

Abstract Several recent studies have provided evidence that use of calcium channel blockers, especially amlodipine and nifedipine, can reduce mortality from Covid-19. Moreover, hypocalcemia (a reduced level of serum ionized calcium) has been shown to be strongly positively associated with Covid-19 severity. Both effectiveness of CCBs as antiviral therapy, and positive associations of hypocalcemia with mortality, have been demonstrated for many other viruses as well. We evaluate these findings in the contexts of virus-host evolutionary conflicts over calcium metabolism, and hypocalcemia as either pathology, viral manipulation, or host defence against pathogens. Considerable evidence supports the hypothesis that hypocalcemia represents a host defence. Indeed, hypocalcemia may exert antiviral effects in a similar manner as do CCBs, through interference with calcium metabolism in virus-infected cells. Prospective clinical studies that address the efficacy of CCBs and hypocalcemia should provide novel insights into the pathogenicity and treatment of Covid-19 and other viruses.

scholarly journals Renoprotective effect of calcium channel blockers

2009 ◽  
Vol 137 (11-12) ◽  
pp. 690-696
Author(s):  
Nada Dimkovic ◽  
Sinisa Dimkovic
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Calcium Channel ◽  
Blood Pressure Control ◽  
Calcium Channel Blockers ◽  
Ace Inhibitors ◽  
Clinical Studies ◽  
Pressure Control ◽  
Channel Blockers ◽  
Glomerular Arterioles

The advancing chronic renal failure is at most the consequence of secondary haemodynamic and metabolic factors as intraglomerular hypertension and glomerular hypertrophy. Although tight blood pressure control is the major preventive mechanism for progressive renal failure, ACE inhibitors and angiotensin receptor blockers have some other renoprotective mechanisms beyond the blood pressure control. That is why these two groups of antihypertensive drugs traditionally have advantages in treating renal patients especially those with proteinuria over 400-1000 mg/day. Even if earlier experimental studies have shown renoprotective effect of calcium channel blockers, later clinical studies did not prove that calcium channel blockers have any advantages in renal protection over ACE inhibitors given as monotherapy or in combination with ACE inhibitors. It was explained by action of calcium channel blockers on afferent but not on efferent glomerular arterioles; a well known mechanism that leads to intraglomerular hypertension. New generations of dihydropiridine calcium channel blockers can dilate even efferent arterioles not causing unfavorable haemodynamic disturbances. This finding was confirmed in clinical studies which showed that renoprotection established by calcium channel blockers was not inferior to that of ACE inhibitors and that calcium channel blockers and ACE inhibitors have additive effect on renoprotection. Newer generation of dihydropiridine calcium channel blockers seem to offer more therapeutic possibilities in renoprotection by their dual action on afferent and efferent glomerular arterioles and, possibly by other effects beyond the blood pressure control.

Calcium Metabolism, Calcium-Channel Blocking Agents, and Hypertension Management

1988 ◽  
Vol 22 (9) ◽  
pp. 659-671 ◽  
Author(s):  
Y.W. Francis Lam
Keyword(s):  
Calcium Channel ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Calcium Channel Blockers ◽  
Calcium Metabolism ◽  
Antihypertensive Agents ◽  
Channel Blockers ◽  
Blocking Agents ◽  
Calcium Channel Blocking Agents ◽  
Channel Blocking

Increasing evidence has suggested that a disturbance of cellular calcium metabolism may have a role in initiating and maintaining elevated systemic vascular resistance in essential hypertension. Controversy exists over whether calcium can alleviate or exacerbate the hypertensive process, and diversity of calcium metabolism in hypertensive patients has been proposed. Calcium-channel blocking agents are potent vasodilators capable of correcting the elevated systemic vascular resistance. Clinical studies have shown that these drugs have antihypertensive efficacy comparable to established agents. The elderly, blacks, and patients with low renin activity respond well to calcium-channel blockers. These drugs may also offer potential advantages over established antihypertensive agents in patients with other coexisting diseases. Sustained release formulations have been developed, and initial experience with long-term efficacy and tolerability is encouraging. The calcium-channel blockers may become first-line therapy for treatment of hypertension in selected patients.

Calcium Channel Blockers in Restoration of Endothelial Function: Systematic Review and Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 26 (29) ◽  
pp. 5579-5595 ◽  
Author(s):  
Miroslav Radenković ◽  
Marko Stojanović ◽  
Milica Prostran
Keyword(s):  
Endothelial Function ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Clinical Studies ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Channel Blockers ◽  
Positive Effects

Background: Clinical evaluation of the Endothelial Function (EF) is becoming an essential step in the quality assessment of cardiovascular risk prevention and rational pharmacotherapy of cardiovascular disorders. The existing pieces of evidence suggested that Calcium Channel Blockers (CCB) can induce positive effects on impaired EF. Objective: To evaluate the effects of CCB on EF, we performed a meta-analysis of available data from randomized and placebo-controlled or other treatment-controlled clinical studies encompassing effects of CCB on EF, as measured by Flow-Mediated Dilation (FMD) of the brachial artery. Methods: The relevant clinical studies were searched by systematic exploration of the appropriate databases until November 30, 2017. A random-effect model was conducted. The primary outcome was the percentage change in FMD between the baseline and the final levels in response to investigated drugs. Results: Fifteen randomized clinical studies with 33 arms were identified. CCB improved FMD more pronounced than thiazide diuretics - TD (3 studies, 157 participants, WMD=2.08%, 95% CI=0.35-3.80%; P=0.02). Oppositely, ACE Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) notably improved FMD if compared to CCB (CCB vs. ACEI: 5 studies, 533 participants, WMD = ‐1.62%, 95% CI = ‐2.74% to ‐0.50%; P=0.005; and CCB vs. ARB: 9 studies, 669 participants, WMD = ‐1.52%, 95% CI = ‐2.22% to ‐0.81%; P=0.0001). CCB effects on EF were similar to those evoked by beta blockers or placebo. Conclusion: CCB improved EF to a more prominent extent only if paralleled to TD, while inversely; ACEI and ARB were more effective in augmenting FMD.

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