Calcium Channel Blockers (CCB) to Prevent Coronary Heart Disease & Stroke

CCB Classification

Calcium channel blocker (CCBs) is a class of drugs used to treat a host of cardiovascular diseases, including hypertension, angina, and/or supraventricular arrhythmias. There are 10 different calcium channel blockers sold in the United States.

The most common calcium channel blockers are diltiazem, amlodipine, verapamil, and nifedipine. Short-term acting calcium channel blockers such as diltiazem, nicardipine, and verapamil can be administered intravenously to provide short-term options for blood pressure (BP) and rate control in the hospitalized patient. Long-term acting calcium channel blockers are used for treatment of chronic hypertension. Side effects of calcium channel blockers include peripheral edema, flushing, and headache.

Calcium channel blockers are very effective in lowering blood pressure, with a response rate greater than 50% for stage I and II hypertension. For most patients, the upward dose titration of a calcium channel blocker will provide substantial reduction in blood pressure. However, the side effects of calcium channel blockers often prevent use of higher doses.

Effects on CHD and Stroke Outcomes

Verdecchia et al. (2005) showed that regimens based on calcium channel blockers were associated with a 17% lower risk of coronary heart disease and a 35% lower risk of stroke in comparison to placebo. In general, 10 mm Hg reduction in systolic blood pressure reduction leads to a 15% reduction in risk of coronary heart disease and stroke.

In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), amlodipine ( a calcium channel blocker) was compared with chlorthalidone (a diuretic) and lisinopril (an ACE inhibitor). It was found that the relative risk for coronary heart disease (CHD) between amlodipine ( a calcium channel blocker) and chlorthalidone (a diuretic) is 0.98 (95% CI, 0.90-1.07). Amlodipine also resulted in higher systolic blood pressure (0.8 mm Hg) at five year follow-up and a higher rate of heart failure (risk ratio: 1.38) in comparison to chlorthalidone.

Summary

Calcium channel blocker therapy has an established role in as a front-line treatment for hypertension either as monotherapy or in combination with other antihypertensive drug classes.

References

Angiotensin-Converting Enzyme Inhibitors and Calcium Channel Blockers for Coronary Heart Disease and Stroke, P Verdecchia, G Reboldi, F Angeli, R Gattobigio, M … - Hypertension, 2005 - Am Heart Assoc

Sica, D.A, Calcium Channel Blocker, Pharmacotherapy Review, 2008.