Division of Cardiology, Department of Medicine, University of Southern California School of Medicine, Los Angeles, Calif., USA

You are watching: Why calcium channel blockers should be avoided in heart failure?

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Publimelted online: March 03, 1998

Number of Publish Pages: 9Number of Figures: 0Number of Tables: 0

ISSN: 0008-6312 (Print) eISSN: 1421-9751 (Online)

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A significant initiative has been made in the last 15 years to evaluate the security and efficacy of calcium channel blockers (CCBs) in the therapy of patients with chronic congestive heart faitempt (CHF). Available researches have actually provided solid evidence for a potential detripsychological impact of the first-generation calcium antagonists in patients through CHF, indicating the need for good caution when these drugs are used in patients through considerable depression of left ventricular systolic attribute. A number of second-generation CCB have demonstrated a strong vasodilatory impact and also favorable hemodynamic activity however fairesulted in present a similar improvement in exercise capacity, morbidity and also mortality. Moreover, drugs such as nicardipine and also nisoldipine have actually led to a detrimental effect in some patients and, therefore, cannot be taken into consideration safe when offered in patients through moderate-to-major heart faientice. Available information from the V-HeFT III examine demonstrate a absence of a negative impact of felodipine on exercise tolerance in patients with chronic heart failure. Although mortality price was comparable in both the felodipine and also the placebo group, because of the fairly small variety of patients in this research, no clear conclusion have the right to be drawn regarding the impact of felodipine on mortality in patients via CHF. An encouraging signal concerning a potential duty of CCB in the treatment of chronic heart faiattract has been gave by the newly completed PRAISE research. This prospective large-scale research demonstrated the safety and security of amlodipine, a long-acting dihydropyridine derivative, once provided in patients through heart faiattract because of coronary artery disease. In addition, this research demonstrated a comprehensive reduction in mortality in patients via CHF as a result of nonischemic cardiomyopathy and offered a solid indication for a potential therapeutic benefit of amlodipine as soon as included to conventional CHF treatment in this patient population. No clear explacountry is accessible at the current time concerning the factor for the deleterious result demonstrated via some of the dihydropyridines and also the contrasting advantage checked out via amlodipine. Finally, more information regarding the safety and security and efficacy of dihydropyridines have to come to be obtainable in the following year. The PRAISE II research is continuous and will provide even more information concerning the therapeutic function of amlodipine in patients via nonischemic dilated cardiomyopathy. The MACH-1 study is evaluating the impact of mibefradil, a predominant T-type channel blocker through an ideal task profile, on morbidity and mortality in patients through chronic CHF.

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Publimelted online: March 03, 1998