Sustained-release calcium channel antagonists in cardiovascular disease: pharmacology and current therapeutic use

Abstract

Calcium channel antagonists are a heterogeneous group of drugs with differing cardiovascular effects, and are effective in the treatment of hypertension and angina pectoris. A number of these agents are available in a sustained-release formulation. These formulations produce a gradual and sustained drop in peripheral vascular resistance, thereby avoiding reflex sympathetic stimulation, and thus may avoid the deleterious effects that have been reported with short-acting preparations. The results of a number of trials with sustained-release calcium channel antagonists have been reported recently, and the results are promising. Currently they can be recommended for use in patients with hypertension or stable angina which cannot be controlled with other agents. They have been shown to be at least safe when used in patients with left ventricular systolic dysfunction, and may be useful in certain subsets of patients with heart failure. The empirical use of calcium channel antagonists in unstable angina and acute myocardial infarction is not supported by the currently available data. Several large trials with sustained-release formulations are ongoing, which may alter treatment recommendations in the future.