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Differential effects of calcium-channel blockers on vascular endothelial function in patients with coronary spastic

Yoichi Miwa1, Hiroyuki Masai, Masatoshi Shimizu

  • 1Department of Internal Medicine, National Hospital Organization Kobe Medical Center, Kobe, Japan. yomiwa-circ@umin.ac.jp

Circulation Journal : Official Journal of the Japanese Circulation Society
|February 20, 2009
PubMed

Insights

Benidipine improved endothelial function in coronary vasospasm patients, unlike diltiazem or verapamil. This suggests dihydropyridine calcium-channel blockers may benefit vascular endothelial function.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Vascular endothelial function is impaired in patients with coronary vasospasm.
  • The differential effects of L-type calcium-channel blocker (CCB) classes on endothelial function in this population remain unclear.

Purpose of the Study:

  • To compare the effects of benidipine (dihydropyridine), diltiazem (benzothiazepine), and verapamil (phenylalkylamine) on vascular endothelial function in patients with coronary vasospasm.

Main Methods:

  • Twenty-five patients with coronary vasospasm received one of the three CCBs for 3 months.
  • Assessed were endothelium-dependent flow-mediated dilatation (FMD), endothelium-independent nitroglycerin-induced dilatation, and plasma cyclic guanosine 3',5'-monophosphate (cGMP).
  • Measurements were taken before and after the treatment period.

Main Results:

  • Patients with vasospasm exhibited lower baseline FMD compared to healthy subjects.
  • Benidipine significantly increased FMD and plasma cGMP levels.
  • Diltiazem and verapamil did not significantly alter FMD or cGMP levels; none of the drugs affected nitroglycerin-induced dilatation.

Conclusions:

  • Benidipine, a dihydropyridine CCB, improves endothelial dysfunction in coronary vasospasm patients, independent of blood pressure reduction.
  • The nitric oxide-cGMP pathway may mediate benidipine's beneficial effects.
  • Dihydropyridine CCBs might offer greater advantages for vascular endothelial function compared to non-dihydropyridine CCBs in this patient group.
Abstract

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