Comparison of isradipine with nitroprusside for control of blood pressure following myocardial revascularization: Effects on hemodynamics, cardiac metabolism, and coronary blood flow

Isradipine—A Review of Its Antihypertensive and Other Properties

“…isradipine resulted in a 44% increase in coronary sinus blood flow, a 43% reduction in coronary vascular resistance, and a 34% reduction in myocardial oxygen extraction, whereas the myocardial oxygen consumption remained unchanged (79). Similar results were obtained in coronary patients without concomitant P-blockade (138) and in patients with hypertension following CABG (135); in this latter group, isradipine increased both the global (coronary sinus) and regional (great cardiac vein) coronary blood flow by about 30% (135).…”

“…On the other hand, with isradipine, there was no tachycardia, and an increase in cardiac output was seen, associated with an increase in stroke index (136). In addition, isradipine, in contrast to SNP, significantly enhanced coronary blood flow (135 respectively (all differences between treatment groups: p < 0.05). Treatment was discontinued before 6 h in 24 patients in each group because of low blood pressure.…”

Coronary and systemic hemodynamic effects of clevidipine, an ultra‐short‐acting calcium antagonist, for treatment of hypertension after coronary artery surgery

“…This was accompanied by a lower SVR, higher cardiac filling pressures and RVEDV compared with SNP, indicating that clevidipine is a more potent systemic vasodilator and a less potent venodilator when compared to SNP. This afterload reducing effect of clevidipine and a lack of effect on venous capacitance vessels after CABG have previously been described for nifedipine, nicardipine and isradipine (18)(19)(20)(21)(22)(23)(24). Incremental infusion rates of clevidipine did not in- duce changes in HR in contrast to that which has been shown in healthy volunteers (unpublished observations).…”

“…There were no differences between clevidipine and SNP with respect to myocardial lactate extraction or uptake when these agents were compared at an identical level of MAP. Also isradipine appears to have comparable effects to SNP on myocardial lactate metabolism after CABG (21). It has previously been shown that nifedipine prevented the decline in myocardial lactate uptake, which was seen with SNP in response to the stress of atrial pacing after CABG (18).…”

Calcium Antagonists for Perioperative Blood Pressure Control

“…1 1 These agents have also been used for perioperative blood pressure control. [1][2][3][4] Calcium antagonists constitute three major classes of pharmacologic agents: phenylalkylamines (eg, verapamil), benzothiazepines (eg, diltiazem), and dihydropyridines (parent drug, nifedipine). Their beneficial clinical effects may be attributed to peripheral and coronary vasodilatation, resulting in reduction in myocardial oxygen consumption and increase in supply, to their antivasospastic effect and to their ability to prevent intracellular calcium overload.…”