An exercise hemodynamic comparison of verapamil, diltiazem, and amlodipine in coronary artery disease

Abstract

A prospective, randomized study compared the effects of equivalent intravenous doses of three slow calcium-channel blockers (verapamil, diltiazem, and amlodipine) on rest and exercise haemodynamics in 30 ischemic heart disease patients. Following a stable control period during which rest and exercise (supine bicycle) hemodynamics were assessed, equivalent hypotensive doses of each compound were administered over 20 minutes and rest/exercise parameters were assessed 10 minutes later. At rest all agents similarly reduced systemic blood pressure; the fall in systemic vascular resistance and the increase in cardiac indices was ranked: amlodipine greater than diltiazem greater than verapamil. The heart rate increase for amlodopine differed from verapamil and diltiazem (+19.4% vs. +1.5% vs. -7%; p less than 0.01). On exercise, similarly greater falls in the systemic vascular resistance index followed amlodipine, compared with verapamil and diltiazem (p less than 0.05). Only amlodipine significantly reduced the exercise pulmonary artery occlusion pressure (PAOP). Exercise cardiac stroke volume improved after diltiazem and amlodipine. In terms of cardiac performance, both amlodipine and diltiazem produced an improvement, whereas verapamil depressed cardiac pumping activity. Thus, hemodynamic differences between slow-calcium-channel blocking drugs may be demonstrated in humans. These differences would be compatible with a predominant peripheral vascular site of action for amlodipine, in contrast with mixed cardiac and peripheral sites for diltiazem and verapamil.

Down the membrane hole: Ion channels in protozoan parasites

“…Analysis of therapeutic drugs currently in clinical use show that ion channels represent the second most frequent target after GPCR [ 302 ] and have been postulated as suitable drug targets against bacterial, viral, and parasitic infections [ 303 – 306 ]. L-type Ca 2+ channel blockers verapamil, amlodipine, diltiazem, and nifedipine are the most prescribed treatment for cardiovascular diseases such as hypertension and angina [ 307 , 308 ]. Ion channel modulators are widely used to treat neurological and psychiatric disorders such as epilepsy, neuropathic pain, anxiety, and depression [ 309 – 314 ].…”

Hemodynamic effects of intravenous elgodipine in coronary artery disease during rest and exercise, and basic pharmacokinetic parameters

“…This profile seems to be a hybrid between calcium channel antagonists, such as verapamil or dilgazem on the one hand, and the dihydropyridines, on the other hand. Elgodipine seems to be similar to verapamil [21] or diltiazem [21,22] for the parameters HR, SBP, and DBP, and to amlodipine [21,23], nisoldipine [20], nicardipine [24], and isradipine [25]) for SVR, CO, and SV, investigated with similar patients and design.…”

The Effects of Calcium Channel Antagonists on Coronary Nitrite Outflow in Isolated Rat Heart

“…Calcium entry blockers are of symptomatic and haemodynamic benefit in the treatment of angina pectoris due to either fixed coronary artery stenoses or to coronary vasospasm [1,2]. Blockade of calcium channels relax vascular smooth musle, which is accompanied by improved left ventricular pumping, including an increased cardiac output, relieved chest pain in patients with stable angina or lowered blood pressure [3−6].…”