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Efficacy and safety of calcium channel blockers in hypertensive patients with concomitant left ventricular
1University of California Medical Center, Cardiology Division, Moffitt Hospital, San Francisco 94143-0124.
Insights
Second-generation calcium channel blockers (CCBs) are beneficial for hypertension with left ventricular dysfunction. These agents improve exercise tolerance and coronary perfusion without significant negative inotropic effects.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension management requires careful consideration of left ventricular function.
- Calcium channel blockers (CCBs) are a class of antihypertensive drugs with varying tissue selectivity.
- Left ventricular dysfunction presents unique challenges in selecting appropriate CCBs.
Purpose of the Study:
- To review the utility of CCBs in patients with hypertension and left ventricular dysfunction.
- To highlight the specific properties of second-generation dihydropyridine CCBs.
- To differentiate CCB suitability based on functional and electrophysiologic effects.
Main Methods:
- Review of existing literature on CCB mechanisms and clinical effects.
- Comparison of second-generation dihydropyridine CCBs with other CCB classes.
- Analysis of CCB impact on cardiac function, oxygen demand, and drug interactions.
Main Results:
- Second-generation dihydropyridine CCBs (e.g., felodipine, nicardipine) offer advantages for hypertensive patients with left ventricular dysfunction.
- These agents increase blood flow, reduce myocardial oxygen requirements, and improve exercise tolerance.
- They generally lack significant negative inotropic effects and have fewer interactions with digoxin compared to first-generation CCBs.
Conclusions:
- Specific CCBs are more appropriate than others for patients with concomitant hypertension and left ventricular dysfunction.
- Second-generation dihydropyridine CCBs are well-suited for this patient population due to their favorable hemodynamic and electrophysiologic profiles.
- These agents can be safely used in patients with angina and coronary heart disease.
Abstract:
The use of calcium channel blockers (CCBs) in the treatment of hypertension and concomitant left ventricular dysfunction is reviewed. Some CCBs, particularly second-generation dihydropyridine agents such as felodipine, isradipine, nicardipine, nimodipine, and nitrendipine, have properties that enhance their usefulness in these patients. All CCBs have a similar mechanism of action. Differences in their selective action at various tissue sites determine which are most appropriate for patients with concomitant hypertension and left ventricular dysfunction. Most CCBs do not produce reflex stimulation of the heart or induce intravascular expansion. While all CCBs produce arteriolar dilation, all local beds and regional circulations in target organs are not affected equally. Most CCBs can decrease cardiac mass, and second-generation CCBs tend to have little or no negative inotropic effects at therapeutic dosages. In addition, they increase blood flow and reduce myocardial oxygen requirements. Because of differences in functional and electrophysiologic effects, specific CCBs may not be appropriate for all patients. Since second-generation dihydropyridine CCBs lack clinically relevant negative inotropic effects, and have been shown to improve exercise tolerance and coronary artery perfusion, they are appropriate for hypertensive patients with left ventricular dysfunction, angina, and coronary heart disease. Second-generation CCBs tend to lack cardiodepressant side effects and are less likely to react with digoxin than are first-generation CCBs.