Rationale for calcium entry-blocking drugs in systemic hypertension complicated by coronary artery disease.
There is considerable rationale for the use of the calcium entry-blocking drugs for the treatment of hypertension and prevention of recurrent episodes of angina pectoris in patients with systemic hypertension and significant coronary artery disease--the 2 entities commonly occurring together. Calcium entry-blocking drugs improve myocardial blood flow while decreasing myocardial oxygen demand. These agents can be given to most patients with ischemic heart disease and its complications, and are associated with a relatively low incidence of serious adverse effects and toxicity during long-term therapy. They reduce the frequency of anginal attacks, prolong exercise time to ST-segment depression or angina and improve exercise capacity. With long-term therapy, tolerance does not develop as it does in many patients with the "long-acting" nitrates. Calcium entry-blocking drugs reduce systolic blood pressure in patients with hypertension by a decrease in peripheral vascular resistance and a uniform improvement in blood flow affecting the myocardium, kidney and brain. There are no central nervous system adverse effects and hypokalemia does not occur. Unlike therapy with the beta-blocking drugs, chronic treatment with the calcium entry blockers does not reduce the serum level of high-density lipoprotein cholesterol nor increase serum triglyceride concentration. The calcium blockers decrease the arterial blood pressure without increasing intravascular plasma volume and are associated with only a slight increase in reflex-mediated sympathetic activity and heart rate, the latter occurring predominantly with nifedipine. Calcium entry-blocking drugs provide alternative or preferred therapy to beta-blocking agents in patients with a combination of hypertension and angina pectoris.(ABSTRACT TRUNCATED AT 250 WORDS)
O'Rourke
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D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000787:Angina Pectoris / Q000517:prevention & control; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D003326:Coronary Circulation / Q000187:drug effects; D003327:Coronary Disease / Q000150:complications*; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D005996:Nitroglycerin / Q000627:therapeutic use; D013997:Time Factors; D014655:Vascular Resistance / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D004232:Diuretics; D005996:Nitroglycerin