Calcium channel blockers in heart failure: help or hindrance?
Since their development, calcium channel blocking agents have stimulated interest in their potential benefit for a variety of cardiovascular disorders, including heart failure. The rationale for the potential benefit of calcium channel blockers in heart failure is multi-factorial, including vasodilation, correction of perturbed diastolic relaxation, anti-ischemic action, and potential for inhibiting myocyte hypertrophy and injury. Despite these potential benefits, the degree of salutary influence has remained controversial, and a number of studies have suggested potential adverse action in patients with heart failure, perhaps linked to either negative inotropic action or to reflex neurohormonal activation. Diversity among different agents, particularly with regard to tissue selectivity and pharmacokinetics may imply substantial differences in the relative benefits and risks in various subgroups of patients with heart failure. One trial with the newer dihydropyridine agent, amlodipine, indicates benefit to survival in patients with moderate to severe heart failure and reduced ejection fraction. The reproducibility of this finding and the mechanism for this benefit deserves further investigation.
Konstam
M A
MA
Department of Medicine, New England Medical Center, Boston, Massachusetts 02111, USA.
Smith
J J
JJ
Patten
R
R
Udelson
J E
JE
D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans
D002121:Calcium Channel Blockers