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[Calcium antagonists in cardiovascular diseases]
1Service de pharmacologie, CHU de Rouen.
Insights
Calcium antagonists block calcium currents, offering therapeutic benefits for cardiovascular conditions like angina and hypertension. Research is exploring their role in atherosclerosis, myocardial infarction prevention, and heart failure treatment.
Area of Science:
- Pharmacology
- Cardiovascular Medicine
Context:
- Calcium antagonists modulate transmembrane calcium currents.
- They counteract increased intracellular ionized calcium levels.
- These actions yield significant vascular and myocardial effects.
Purpose:
- To elucidate the therapeutic applications of calcium antagonists.
- To review their efficacy in various cardiovascular conditions.
- To highlight areas of ongoing research.
Summary:
- Calcium antagonists induce vascular and myocardial relaxation, increasing coronary flow and reducing afterload, thus decreasing myocardial oxygen consumption.
- Specific agents like verapamil and diltiazem are effective in stable angina and post-infarction scenarios, with verapamil reducing mortality.
- These drugs are broadly effective in hypertension, offering target organ protection.
Impact:
- Calcium antagonists are established treatments for angina and hypertension.
- Ongoing research focuses on their potential in atherosclerosis, myocardial infarction prevention, and heart failure.
- These agents represent valuable therapeutic tools in cardiovascular medicine.
Abstract:
By blocking the inward transmembrane calcium current and opposing the effects of increased intracellular ionised calcium, calcium antagonists exert vascular and myocardial effects which are useful therapeutic tools. Coronary and peripheral vascular relaxation results in an increase in coronary flow and a reduction of the afterload and, therefore, of myocardial oxygen consumption. In some cases, negative myocardial inotropic and chronotropic effects also reduce myocardial oxygen requirements. Spastic angina is the indication of choice of all calcium antagonists whereas, to date, verapamil and diltiazem have been shown to be effective in stable angina and, in the post-infarction situation, diltiazem and verapamil decrease the number of cardiovascular events, and verapamil alone has been shown to reduce mortality. All calcium antagonists have been shown to be effective in hypertension and most have a protective effect on the target organs. The main fields of research concern atherosclerosis, the primary prevention of myocardial infarction and the study of molecules which can be used in heart failure.