Calcium antagonists in patients with left ventricular dysfunction: back on the bridge?

Journal of Cardiac Failure
B S Lewis

Abstract

Calcium antagonists have a useful role in the management of patients with cardiac disease, producing coronary and systemic vasodilatation and an additional possibly beneficial effect on ventricular diastolic function. On the other hand, the myocardial depressant effect of the first-generation drugs and the abrupt changes in blood pressure, with neurohormonal activation, have been associated with worsening heart failure in certain patients. The present review summarizes the data currently available, with emphasis on the newer slow-release and long-acting calcium antagonists. Use of these drugs minimizes the peak and trough effect associated with short-acting preparations, and particularly when administered against a background of digoxin, diuretic and angiotensin converting enzyme inhibitors, may be associated with better long-term results in patients with ventricular dysfunction. The DEFIANT studies, using nisoldipine-coat core, showed that nisoldipine-CC improved diastolic ventricular function and had a significant anti-ischemic effect in patients with mild-moderate ventricular dysfunction after acute myocardial infarction. The VHeFT III trial showed that felodipine had no effect on exercise capacity or survival in patients wi...Continue Reading

References

Jan 1, 1992·Journal of Cardiovascular Pharmacology·T GodfraindJ C Schoevaerts
Aug 18, 1988·The New England Journal of Medicine·UNKNOWN Multicenter Diltiazem Postinfarction Trial Research Group
Nov 8, 1986·British Medical Journal·R G WilcoxH G Mather
Jan 1, 1986·The American Journal of Cardiology·D A WeinerM D Klein
Jun 5, 1980·The New England Journal of Medicine·E AntmanE Braunwald

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