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Rationale for calcium entry-blocking drugs in systemic hypertension complicated by coronary artery disease
Insights
Calcium entry-blocking drugs effectively treat hypertension and prevent angina in patients with coronary artery disease. These medications offer improved blood flow and reduced oxygen demand with minimal side effects during long-term use.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension and coronary artery disease frequently coexist.
- Calcium entry-blockers offer a therapeutic option for these patients.
Purpose of the Study:
- To evaluate the efficacy and safety of calcium entry-blocking drugs.
- To compare their effects with other antihypertensive and antianginal agents.
Main Methods:
- Review of existing literature on calcium entry-blocker pharmacology and clinical trials.
- Analysis of effects on blood pressure, myocardial oxygen demand, and exercise capacity.
Main Results:
- Calcium entry-blockers improve myocardial blood flow and reduce oxygen demand.
- They effectively lower blood pressure by decreasing peripheral vascular resistance.
- These drugs demonstrate a low incidence of serious adverse effects and do not cause hypokalemia or negative lipid profile changes.
Conclusions:
- Calcium entry-blocking drugs are a valuable treatment for hypertension and angina.
- They offer an alternative or preferred therapy to beta-blockers in patients with combined conditions.
- Long-term therapy is well-tolerated without developing tolerance.
Abstract:
There is considerable rationale for the use of the calcium entry-blocking drugs for the treatment of hypertension and prevention of recurrent episodes of angina pectoris in patients with systemic hypertension and significant coronary artery disease--the 2 entities commonly occurring together. Calcium entry-blocking drugs improve myocardial blood flow while decreasing myocardial oxygen demand. These agents can be given to most patients with ischemic heart disease and its complications, and are associated with a relatively low incidence of serious adverse effects and toxicity during long-term therapy. They reduce the frequency of anginal attacks, prolong exercise time to ST-segment depression or angina and improve exercise capacity. With long-term therapy, tolerance does not develop as it does in many patients with the "long-acting" nitrates. Calcium entry-blocking drugs reduce systolic blood pressure in patients with hypertension by a decrease in peripheral vascular resistance and a uniform improvement in blood flow affecting the myocardium, kidney and brain. There are no central nervous system adverse effects and hypokalemia does not occur. Unlike therapy with the beta-blocking drugs, chronic treatment with the calcium entry blockers does not reduce the serum level of high-density lipoprotein cholesterol nor increase serum triglyceride concentration. The calcium blockers decrease the arterial blood pressure without increasing intravascular plasma volume and are associated with only a slight increase in reflex-mediated sympathetic activity and heart rate, the latter occurring predominantly with nifedipine. Calcium entry-blocking drugs provide alternative or preferred therapy to beta-blocking agents in patients with a combination of hypertension and angina pectoris.(ABSTRACT TRUNCATED AT 250 WORDS)