Coronary benefits of calcium antagonist therapy for patients with hypertension.
Calcium antagonists effective in lowering blood pressure are a heterogeneous group including three main classes: phenylalkylamines, benzothiazepines and dihydropyridines. Dihydropyridines have a dual mode of action upon the endothelium contributing to their beneficial antihypertensive effects: (1) direct relaxation by inhibition of smooth muscle L-type calcium current, and (2) indirect relaxation through release of nitric oxide from the vascular endothelium. Calcium antagonists may affect many calcium-dependent events in the formation of atherosclerosis such as the localized accumulation of collagen, elastin, and calcium together with monocyte infiltration and smooth muscle proliferation and migration. In the INSIGHT calcification study, the overall treatment effect of nifedipine demonstrated significant inhibition of coronary calcium progression over a three-year period. Calcium antagonists improve symptoms and reduce ischemia in hypertensive patients with ischemic heart disease. Although in placebo-controlled trials calcium antagonists demonstrated a significant reduction in cardiovascular morbidity and mortality, they may be less effective than other types of antihypertensive drugs in preventing ischemic heart disease.
Motro
M
M
Cardiac Rehabilitation Institute, The Sheba Medical Center, Tel-Hashomer, Israel. motrom@post.tau.ac.il
Shemesh
J
J
Grossman
E
E
D000787:Angina Pectoris / Q000188:drug therapy; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000188:drug therapy; D003331:Coronary Vessels / Q000187:drug effects*; D003920:Diabetes Mellitus / Q000188:drug therapy; D004730:Endothelium, Vascular / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007022:Hypotension / Q000139:chemically induced; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers