CHAPTER 11 Clinical Pharmacology of Cardiovascular Drugs
Treatment of cardiovascular (CV) disease often requires the administration of numerous medications for long periods of time to patients likely to be old and suffering from a range of comorbid conditions. Rational prescribing informed by clinical pharmacology is essential if the right drug is to be administered to the right patient, at the right time, and for the right price. This requires an appreciation of the key principles of clinical pharmacology, and specific knowledge of individual therapies. Knowledge of polypharmacy and drug interactions is crucial, and the pharmacokinetic and pharmacodynamic challenges associated with advanced patient age, comorbidity, and sometimes frailty must be addressed and overcome. The environmental and genetic determinants of variability in response to treatment are increasingly well understood, and new biomarkers and pharmacogenetic techniques provide the foundations of the emerging discipline of personalized medicine. Long-term preventive medication raises issues concerning safety, adherence, and cost to healthcare providers. A basic familiarity with the principles of pharmaco-vigilance, pharmaco-epidemiology, and pharmaco-economics may therefore be of some value to practitioners.No other medical discipline has progressed as fast as CV medicine. The high incidence and prevalence of CV disease has created a huge epidemiological challenge, and an enormous potential market for the pharmaceutical industry, which continues to play a very important role in research and development. The aim of CV therapy is as much to improve quality of life as to prolong survival. Its efficacy is often measured using hard morbidity and mortality endpoints requiring sophisticated long-term clinical trials. Consequently, therapeutic decisions in CV medicine are more evidence based than is possible in other specialties, and the results of major trials have shaped routine practice. It is therefore essential for those training in cardiology and CV medicine to be taught to assess the evidence provided by the literature and use it to make informed individual therapeutic decisions.
This chapter summarizes the principles of clinical pharmacology relevant to CV drug therapy and introduces fundamental concepts in the critical appraisal of trial data. It provides an overview of the critical characteristics of drugs commonly used to treat CV disease.
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