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[Differential therapy with calcium antagonists. Hemodynamic studies using nifedipine, verapamil and diltiazem]
Insights
Calcium channel blockers like nifedipine, verapamil, and diltiazem lower blood pressure in coronary heart disease patients. However, they affect heart rate and stroke volume differently, suggesting varied therapeutic uses.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary heart disease (CHD) management often involves calcium channel blockers.
- Understanding the differential hemodynamic effects of these drugs is crucial for optimizing patient care.
Purpose of the Study:
- To compare the hemodynamic effects of nifedipine, verapamil, and diltiazem in patients with CHD.
- To evaluate the impact of these calcium antagonists on systemic arterial pressure, left-ventricular stroke work, heart rate, and stroke volume.
Main Methods:
- An open randomized parallel study involving 44 patients with CHD.
- Hemodynamic parameters were measured at rest and during exercise, before and after single doses of nifedipine (20 mg), verapamil (160 mg), and diltiazem (120 mg).
Main Results:
- All three drugs significantly reduced systemic arterial pressure (10-14%) and left-ventricular stroke work (10-20%).
- Nifedipine increased heart rate, while verapamil and diltiazem decreased it.
- Verapamil reduced stroke-volume index, whereas nifedipine and diltiazem did not alter it.
Conclusions:
- Nifedipine, verapamil, and diltiazem exhibit distinct hemodynamic profiles.
- These differences suggest that the choice of calcium antagonist may be tailored to individual patient needs in CHD management.
Abstract:
The haemodynamic effects of nifedipine, verapamil and diltiazem were measured and compared in an open randomized parallel investigation on 44 patients with coronary heart disease and compensated myocardial function. Each set of parameters was measured during a control phase and serially after a single dose (nifedipine in retard form, 20 mg; verapamil, 160 mg; diltiazem, 120 mg) over a period of 180 minutes at rest and after a standardized exercise. All three drugs produced a significant fall in systemic arterial pressure of 10-14% and of left-ventricular stroke work of 10-20% from the initial level. The main differences between the three drugs concerned heart rate and stroke volume. Nifedipine produced a significant rise in heart rate, while it fell by 8-10% below the control value after verapamil and diltiazem. On the other hand, verapamil caused a significant fall in stroke-volume index, while after nifedipine and diltiazem it remained unchanged. These results suggest differential therapeutic use of the various calcium antagonists.
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