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Published on: October 18, 2018
Calcium channel blockers
William J Elliott1, C Venkata S Ram
1Department of Preventive Medicine, Rush Medical College, Rush University, Chicago, IL, USA. welliott@rush.edu
Insights
Calcium channel blockers effectively lower blood pressure in all patient groups and are approved for angina and cardiac dysrhythmias. While beneficial for cardiovascular disease, they are less effective than diuretics for heart failure.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Calcium channel blockers (CCBs) are a cornerstone in managing hypertension and cardiovascular diseases.
- Their mechanism involves inhibiting calcium influx into vascular smooth muscle and cardiac cells, leading to vasodilation and reduced cardiac workload.
Purpose of the Study:
- To provide practical recommendations on the use of calcium channel blockers based on current evidence.
- To highlight their efficacy, limitations, and side effect profiles across diverse patient populations.
Main Methods:
- Review of extensive comparative randomized trials and clinical experience.
- Analysis of CCB efficacy in blood pressure reduction, cardiovascular event prevention, and specific conditions like angina and dysrhythmias.
Main Results:
- CCBs effectively lower blood pressure across all demographics and are indicated for angina and cardiac dysrhythmias.
- Nondihydropyridine CCBs offer negative chronotropic and inotropic effects beneficial for dysrhythmias and in conjunction with beta-blockers.
- CCBs can prevent major cardiovascular diseases, except heart failure, where diuretics are superior. Dihydropyridine CCBs show less benefit in slowing renal disease progression compared to renin-angiotensin system inhibitors, though nondihydropyridines can reduce albuminuria.
Conclusions:
- Calcium channel blockers are versatile agents for cardiovascular disease management, with specific subclasses offering distinct advantages.
- Careful consideration of side effects, drug interactions, and specific patient conditions is crucial for optimal therapeutic outcomes.
Abstract:
KEY POINTS AND PRACTICAL RECOMMENDATIONS: • Calcium channel blockers, which dilate arteries by reducing calcium flux into cells, effectively lower blood pressure, especially in combination with other drugs, and some formulations of agents of this class are approved for treating angina or cardiac dysrhythmias. • Calcium channel blockers reduce blood pressure across all patient groups, regardless of sex, race/ethnicity, age, and dietary sodium intake. • Nondihydropyridine calcium channel blockers are more negatively chronotropic and inotropic than the dihydropyridine subclass, which is important for patients with cardiac dysrhythmias or who need β-blockers. • Extensive experience in comparative randomized trials indicates that an initial calcium antagonist can prevent all major types of cardiovascular disease, except heart failure (for which a diuretic is superior). Initial dihydropyridine calcium channel blockers have not reduced the rate of progression of renal disease as well as inhibitors of the renin-angiotensin system, although members of the nondihydropyridine subclass can reduce albuminuria. • High doses of dihydropyridine calcium channel blockers often cause edema, headache, flushing and tachycardia; high doses of verapamil can cause constipation. Diltiazem and verapamil have important drug interaction with digoxin and cyclosporine, among others.
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