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Use of calcium antagonists in patients with ischemic heart disease and systemic hypertension
1Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.
Insights
Calcium antagonists show promise for treating both ischemic heart disease (IHD) and hypertension. However, caution is advised due to potential cardiovascular risks with certain formulations.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Ischemic heart disease (IHD) and systemic hypertension frequently coexist.
- Hypertension exacerbates IHD, highlighting the need for dual-action therapies.
Purpose of the Study:
- To evaluate calcium antagonists as a monotherapy for patients with coexisting IHD and hypertension.
- To review the efficacy and safety of calcium antagonists in this patient population.
Main Methods:
- Review of randomized, double-blind clinical trials comparing calcium antagonists (verapamil, diltiazem, nifedipine) with other agents (e.g., propranolol).
- Assessment of therapeutic effects including vasodilation, negative inotropy, and nodal conduction reduction.
- Evaluation of impact on angina, hypertension, exercise tolerance, and patient compliance.
Main Results:
- Verapamil demonstrated efficacy comparable to propranolol for angina and hypertension.
- Diltiazem and nifedipine, including long-acting diltiazem, were effective in managing combined IHD and hypertension.
- These agents improved exercise tolerance and compliance.
Conclusions:
- Calcium antagonists offer a potential monotherapy for combined IHD and hypertension.
- Concerns exist regarding the safety of certain calcium antagonists, particularly short-acting dihydropyridines, due to potential increases in cardiovascular morbidity and mortality.
- Further prospective trials are needed to definitively establish safety and efficacy for first-line therapy.
Abstract:
Ischemic heart disease (IHD) and systemic hypertension commonly coexist in a large number of patients, and the presence of hypertension is a risk factor for worsening IHD. A monotherapy that would effectively treat both is thus an attractive idea, and calcium antagonists have been evaluated in this role. Calcium antagonists exert therapeutic effects through a combination of actions, including systemic and peripheral vasodilation, negative inotropy, and reduced nodal conduction. In randomized, double-blind clinical trials, verapamil compares favorably with propranolol in the alleviation of angina and hypertension. Both diltiazem and nifedipine, as well as long-acting diltiazem, are also effective in treating the combined condition. In addition, each of these drugs enhances exercise tolerance and favors compliance with calcium antagonist therapy. Recent questions regarding the safety of this class of drug have tempered the enthusiasm for their use as first-line therapy in cardiovascular disease. In particular, short-acting dihydropyridine derivatives, including nifedipine and isradipine, may increase cardiovascular morbidity and mortality because of reflex sympathetic stimulation. The results of appropriately controlled, prospective clinical trials will provide more definitive conclusions. For now, we must be cautious in the use of calcium antagonist monotherapy for combined IHD and hypertension.