Summary
Arterial hypertension and arteriosclerosis are dramatic consequences of vascular calcium overload. Acute intracellular calcium overload of vascular smooth muscle cells produces hypercontractility. Hypertension develops if a general increase in systemic arteriolar tone leads to a rise in peripheral flow resistance. Moreover, progressive elevation of calcium destroys the structural integrity of the arterial and arteriolar walls. Thus, in various animal models, calcium overload initiates lesions of an arteriosclerotic character. Interestingly, conventional human coronary plaques also represent a calcium-dominated type of arteriosclerosis.
With the advent of specific calcium antagonists, the pathogenic effects of calcium overload and its deleterious consequences have become, for the first time, accessible to therapeutic intervention. Accordingly, adequate treatment with calcium antagonists prevents calcium overload and can thereby protect arteries and arterioles from functional disturbances and structural damage. In spontaneously hypertensive rats, specific calcium antagonists of the verapamil, nifedipine and diltiazem type normalise blood pressure (BP) by reducing transmembrane calcium influx into vascular smooth muscle cells. However, in addition to controlling BP, these drugs also act as tissue protective agents. The long term effects of calcium antagonists such as verapamil in experimental hypertension include the prevention of severe arteriosclerosis, myocardial hypertrophy, and malignant nephrosclerosis. In humans, the antihypertensive efficacy of verapamil is well documented. Further clinical studies have yet to evaluate the antiarteriosclerotic and tissue protective potential of verapamil in humans.
Similar content being viewed by others
References
Aoki K. Three-way classification of hypertension: gene hypertension, environment hypertension, and disease hypertension. In Aoki K (Ed.) Essential hypertension 2, pp. 9–33, Springer-Verlag, Tokyo, 1989
Baudouin-Legros M, Meyer P. Hypertension and atherosclerosis. Journal of Cardiovascular Pharmacology 15(Suppl. 1): S1–S6, 1990
Czirfusz A, Fleckenstein-Grün G. Increased ‘leak’ and stimulated (by K-rich solution and endothelin 2) net 45Ca uptake into aortic media cells of SHRs compared to WKY. Naunyn-Schmiedebergs Archives of Pharmacology 344(Suppl. 2): R105, 1991
Fleckenstein A. Specific inhibitors and promoters of calcium action in the excitation-contraction coupling of heart muscle and their role in the prevention or production of myocardial lesions. In Harris P, Opie L (Eds) Calcium and the heart. Proceedings of the Meeting of the Europe Section of the International Study Group for Research in Cardiac Metabolism, London, Sep 1970, pp. 135–188, Academic Press, London, 1971
Fleckenstein A. Specific pharmacology of calcium in myocardium, cardiac pacemakers, and vascular smooth muscle. Annual Review of Pharmacology and Toxicology 17: 149–166, 1977
Fleckenstein A. History of calcium antagonists. In Schwartz A, Taira N (Eds) Calcium channel blocking drugs: a novel intervention for the treatment of cardiac disease, Monograph No. 95 of the American Heart Association. Circulation Research 52(Part II): 3–16, 1983a
Fleckenstein A. Calcium antagonism in heart and smooth muscle–experimental facts and therapeutic prospects. Monograph, John Wiley Publishing Company, New York, 1983b
Fleckenstein A, Fleckenstein-Grün G. Cardiovascular protection by Ca antagonists. European Heart Journal 1: 15–21, 1980
Fleckenstein A, Fleckenstein-Grün G, Frey M, Zorn J. Future directions in the use of calcium antagonists. American Journal of Cardiology 59: 177B–187B, 1987a
Fleckenstein A, Frey M, Fleckenstein-Grün G. Protection by calcium antagonists against experimental arterial calcinosis. In Pyörälä K, et al. (Eds) Secondary prevention of coronary heart disease. Workshop of the International Society and Federation of Cardiology, Titisee, Oct 1983, pp. 109–122, Thieme Verlag, Stuttgart, 1983
Fleckenstein A, Frey M, Fleckenstein-Grün G. Antihypertensive and arterial anticalcinotic effects of calcium antagonists. American Journal of Cardiology 57: 1D–10D, 1986
Fleckenstein A, Frey M, Thimm F, Fleckenstein-Grün G. Excessive mural calcium overload–a predominant causal factor in the development of stenosing coronary plaques in humans. Cardiovascular Drugs and Therapy 4: 1005–1014, 1990b
Fleckenstein A, Frey M, Zorn J, Fleckenstein-Grün G. Experimental basis of the long-term therapy of arterial hypertension with calcium antagonists. American Journal of Cardiology 56: 3H–14H, 1985
Fleckenstein A, Frey M, Zorn J, Fleckenstein-Grün G. The role of calcium in the pathogenesis of experimental arteriosclerosis. Trends in Pharmacological Sciences 8: 496–501, 1987b
Fleckenstein A, Frey M, Zorn J, Fleckenstein-Grün G. Calcium, a neglected key factor in hypertension and arteriosclerosis. Experimental vasoprotection with calcium antagonists or ACE inhibitors. In Laragh JH, Brenner BM (Eds) Hypertension: pathophysiology, diagnosis, and management, pp. 471–509, Raven Press, New York, 1990a
Fleckenstein A, Kammermeier H, Döring HJ, Freund HJ, Grün G, et al. Zum Wirkungsmechanismus neuartiger Koronardilatatoren mit gleichzeitig Sauerstoff-einsparenden Myokard-Effekten, Prenylamin und Iproveratril. Zeitschrift für Kreislaufforschung 56: 716–744, 839-858, 1967
Fleckenstein-Grün G. Role of transmembrane Ca++ supply in phasic and tonic activation of vascular smooth muscle–vasodilator efficacy of calcium antagonists. In Berman MC, et al. (Eds) Membranes and muscles. Proceedings of an International Symposium in Cape Town, March, 1985. IRL Press, ICSU Symposium Series 6: 235–255, 1985
Fleckenstein-Grün G, Fleckenstein A. Calcium antagonism, a basic principle in vasodilation. In Zanchetti A, Krikler DM (Eds) Calcium antagonism in cardiovascular therapy: experience with verapamil. International Symposium in Florence, Italy, Oct 1980, pp. 30–38, Excerpta Medica, Amsterdam, 1981
Fleckenstein-Grün G, Fleckenstein A. Calcium–a neglected key factor in arteriosclerosis. The pathogenetic role of arterial calcium overload and its prevention by calcium antagonists. Proceedings of the 1st International Duodecim Symposium inflammation and Atherogenesis’, Tampere/Finland, May 1991. Annals of Medicine 23: 589–599, 1991
Grün G, Fleckenstein A. Die elektro-mechanische Entkoppelung der glatten Gefassmuskulatur als Grundprinzip der Coronardilatation durch 4-(2′-Nitrophenyl)-2, 6-dimethyl-1, 4-dihydropyridin-3, 5-dicarbonsäure-dimethylester (Bay a 1040, Nifedipin). Arzneimittel-Forschung 22: 334–344, 1972
Hof RP, Tapparelli C, Weinstein DB. Hemodynamic, antivasoconstrictor, and antiatherosclerotic effects of calcium antagonists in animal models of atherosclerosis. Journal of Cardiovascular Pharmacology 15(Suppl. 1): S7–S12, 1990
Janke J, Hein B, Pachinger O, Leder O, Fleckenstein A. Hemmung arteriosklerotischer Gefässprozesse durch prophylaktische Behandlung mit MgCl2, KCl und organischen Ca++-Antagonisten (quantitative Studien mit 45Ca bei Ratten). In Betz E (Ed.) Vascular smooth muscle, verh Satel Symp XXV International Congress of Physiology, Wissenschaften, Tübingen, July 1971, pp. 71–72, Springer-Verlag, Berlin, 1972
Koutouzov S, Remmal A, Girard A, Meyer P, Marche P. Increased platelet phospholipase C activity: a molecular basis for the cellular hyperactivity in primary hypertension. In Meyer P, Marche P (Eds) Blood cells and arteries in hypertension and atherosclerosis, pp. 141–156, Raven Press, New York, 1989
Resink TJ, Bühler FR. Dysfunctions of calcium extrusion in hypertension. In Meyer P, Marche P (Eds) Blood cells and arteries in hypertension and atherosclerosis, pp. 157–169, Raven Press, New York, 1989
Rusch NJ, Hermsmeyer K. Calcium currents are altered in the vascular muscle cell membrane of spontaneously hypertensive rats. Circulation Research 63: 997–1002, 1988
Seuwen K, Chambard JC, L’Allemain G, Magnaldo I, Paris S, et al. Thrombin as a growth factor: mechanism of signal transduction. In Meyer P, Marche P (Eds) Blood cells and arteries in hypertension and atherosclerosis, pp. 217–232, Raven Press, New York, 1989
Van Breemen C, Saida K. Cellular mechanisms regulating (Ca2+)1 smooth muscle. Annual Review of Physiology 51: 315–319, 1989
Yamori Y, Nara Y, Shimizu S, Mano M, Nabika T. Common cellular mechanisms in the development of hypertension and atherosclerosis. In Meyer P, Marche P (Eds) Blood cells and arteries in hypertension and atherosclerosis, pp. 233–245, Raven Press, New York, 1989
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Fleckenstein-Grün, G., Frey, M., Thimm, F. et al. Calcium Overload — An Important Cellular Mechanism in Hypertension and Arteriosclerosis. Drugs 44 (Suppl 1), 23–30 (1992). https://doi.org/10.2165/00003495-199200441-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-199200441-00005