Related Experiment Video
Updated: Jun 23, 2026
Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
Calcium antagonist drugs in hypertensive patients with angina pectoris
1Medizinische Universitätsklinik Freiburg im. Breisgau, Abteilung Innere Medizin III, Germany.
Insights
Arterial hypertension and coronary artery disease (CAD) are closely linked, with hypertension significantly increasing CAD risk. While calcium antagonists offer benefits for hypertensive patients, their effectiveness in established CAD requires further investigation.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Background:
- Arterial hypertension is a significant risk factor for coronary artery disease (CAD) and left ventricular hypertrophy.
- Hypertension is prevalent in patients with CAD, and myocardial ischemia can occur with or without CAD in hypertensive individuals.
- Mechanisms for ischemia in hypertension include increased coronary resistance, vascular wall changes, endothelial dysfunction, and left ventricular hypertrophy-induced diffusion limitations.
Purpose of the Study:
- To explore the relationship between arterial hypertension, myocardial ischemia, and coronary artery disease.
- To investigate the role of left ventricular hypertrophy in myocardial ischemia in hypertensive patients.
- To evaluate the potential benefits of calcium antagonists in hypertensive patients with and without established CAD.
Main Methods:
- Review of existing literature on hypertension, myocardial ischemia, and coronary artery disease.
- Analysis of the prevalence and associations between these conditions.
- Examination of the proposed mechanisms of myocardial ischemia in hypertensive patients.
Main Results:
- Hypertension is a major risk factor for CAD and left ventricular hypertrophy.
- Myocardial ischemia in hypertensive patients can stem from various vascular and structural changes.
- A high percentage (90%) of myocardial ischemia episodes in hypertensive patients are asymptomatic, with the highest incidence in inadequately controlled elderly men.
- Calcium antagonists show potential benefits like blood pressure reduction and regression of left ventricular hypertrophy, but their efficacy in established human CAD is uncertain, showing only mild reduction in new atherosclerotic lesions.
Conclusions:
- Arterial hypertension is a critical factor in the development of myocardial ischemia and CAD.
- Left ventricular hypertrophy exacerbates ischemia risk in hypertensive individuals.
- While calcium antagonists offer some benefits in hypertension management, their role in established coronary atherosclerosis needs further clarification.
Abstract:
Arterial hypertension frequently occurs in association with myocardial ischaemia and is an independent and significant risk factor for the development of coronary artery disease (CAD), as is left ventricular hypertrophy due to arterial hypertension. The prevalence of CAD in patients with hypertension is high, while hypertension occurs in approximately 60% of patients with CAD. Myocardial ischaemia occurs both in the presence and absence of CAD, probably as the result of limitation of coronary vasodilator capacity and reduction in coronary flow. This may occur in hypertension due to increased transmural coronary artery resistance, alterations in the vascular wall and endothelial dysfunction. Furthermore, left ventricular hypertrophy itself predisposes the heart towards ischaemia due to an increased diffusion distance between capillaries. When myocardial ischaemia occurs in hypertensive patients, 90% of all episodes are aysmptomatic. The highest incidence of ischaemic episodes appears to occur in treated elderly hypertensive men with inadequate blood pressure control (40%). Calcium antagonists exert a range of beneficial effects in hypertensive patients, including reduction of blood pressure, improvement in myocardial blood flow, regression of left ventricular hypertrophy and cardioprotection in reperfused organs. However, while vasoprotective effects have been demonstrated in animal models, beneficial effects in man are uncertain. Thus, in established coronary atherosclerosis, calcium antagonist treatment has produced only a mild reduction in the appearance of new atherosclerotic lesions.
More Related Videos
Related Concept Videos
01:18Antihypertensive Drugs: Action of Calcium Channel Blockers
01:24Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers
01:20Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:16Antianginal Drugs: Nitrates and β-Blockers
Organic nitrates, such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow. Administered...
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...