Calcium channel blockers in the spectrum of antihypertensive agents

Abstract

Calcium channel blockers (CCBs) are widely used in the treatment of hypertension. Through blood pressure reduction, and possibly other mechanisms such as antioxidative effects, they may play a role in diminishing the risk for a variety of cardiovascular outcomes. The combination of CCBs with other newer antihypertensive agents such, as ACE inhibitors and angiotensin receptor blockers, may provide complementary effects on risk reduction in cardiovascular adverse events and renal disease. Although the efficacy of CCBs as antihypertensive agents has been adequately demonstrated, there have been concerns regarding the use of short acting dihydropyridines after acute myocardial infarction. There have also been questions about the role of CCBs with regards to other antihypertensive agents in renal disease. For example, differential effects of dihydropyridine and non-dihydropyridine CCBs may affect progression of renal disease and risk for diabetes. Certain precautions involving drug interactions are needed because of the effects of CCBs on the CYP450 enzyme systems.

Management of cardiovascular risk with RAS inhibitor/CCB combination therapy

“…Blockade of the RAS provides clear benefits in preventing heart failure and the progression of renal disease in patients with hypertension. 20 The benefits of DHPCCBs in CVD prevention may be related to antioxidative effects that result in antiatherosclerotic properties, 20,41,61 a hypothesis that is supported by the results of studies such as CAMELOT. 41,52 …”

“…18,19 Combination treatment appears to offer a number of advantages over higher doses of single agents, including better BP control and improved tolerability and adherence. 20 This article presents an overview of RAS blocker and CCB outcome trials and the rationale for the use of RAS blocker/DHP-CCB combination therapy to reduce global cardiovascular risk in patients with hypertension.…”

“…[57][58][59] Long-acting DHP-CCBs are effective BP-lowering agents across a range of patient groups, including the elderly and African-Americans, and are suitable components of combination therapy with a wide variety of antihypertensive classes. 15,20 Combining RAS blockade with a long-acting DHP-CCB may provide complementary effects that lead to more global risk-factor reduction 20,60 and better outcome as shown in the ACCOMPLISH study. Blockade of the RAS provides clear benefits in preventing heart failure and the progression of renal disease in patients with hypertension.…”

“…11,20,24,34 Importantly, LIFE was the first end-point trial in patients with hypertension to show a divergent therapeutic outcome for one treatment modality over another with equivalent BP control. 35 More recently, the Jikei Heart Study also reported improved outcomes with RAS blockade despite equivalent BP control.…”

“…14 Low-dose combination therapy is usually more effective than monotherapy with higher doses of either component agent. 20 Fixed-dose combination formulations also simplify treatment regimens, which may improve adherence with therapy. 54,55 Combination therapy to lower BP is an important treatment strategy in patients with high-risk conditions, such as diabetes, chronic kidney disease or subclinical target organ damage, and in patients with higher pretreatment BP.…”