Calcium-channel blockers in ischemic heart disease

Recent reports add to a growing body of evidence that short-acting calcium-channel blockers, whether used for hypertension, unstable angina, or acute myocardial infarction, may have unfavorable effects. Short-acting nifedipine has no role in acute myocardial infarction, and the United States Food and Drug Administration has recently issued a warning discouraging its use in hypertension and unstable angina. Other short-acting calcium antagonists such as diltiazem and verapamil may have associated adverse effects as well, although the evidence is not as definitive. What effect sustained-release preparations and newer calcium antagonists have on the clinical endpoints of myocardial infarction and death is not known, and large prospective randomized clinical trials with these medications, some of which are underway, are needed to address these issues. Until that time, only medications with clearly documented efficacy and safety should be used for first-line therapy for hypertension, unstable angina, and acute myocardial infarction.