From the Guidelines
Nifedipine is a dihydropyridine calcium channel blocker (CCB) antihypertensive medication. It works by blocking calcium channels in the smooth muscle cells of blood vessels, preventing calcium from entering these cells. This causes vasodilation (widening of blood vessels), which reduces peripheral vascular resistance and lowers blood pressure 1.
Key Characteristics of Nifedipine
- Available in immediate-release and extended-release formulations
- Extended-release versions are preferred for hypertension management due to more consistent blood pressure control and fewer side effects
- Typical dosing for hypertension ranges from 30-90 mg once daily for extended-release formulations
- Common side effects include peripheral edema, flushing, headache, and dizziness
Clinical Use of Nifedipine
Nifedipine is particularly effective for isolated systolic hypertension in older adults and can be used in combination with other antihypertensive classes like ACE inhibitors, ARBs, or diuretics for enhanced blood pressure control in resistant hypertension 1. However, immediate-release nifedipine should be avoided in the absence of concomitant beta blockade due to increased adverse potential 1.
Comparison with Other CCBs
While different CCBs are structurally and potentially therapeutically diverse, superiority of one agent over another in UA/NSTEMI has not been demonstrated, except for the increased risks posed by rapid-release, short-acting dihydropyridines such as nifedipine 1.
Important Considerations
- Nifedipine can cause hypotension, worsening heart failure, bradycardia, and AV block
- Verapamil and diltiazem should be avoided in patients with pulmonary edema or evidence of severe LV dysfunction
- Long-acting dihydropyridine agents are preferred over nondihydropyridines for use in combination with beta-adrenoceptor blockers, to avoid excessive bradycardia or heart block 1.
From the FDA Drug Label
Nifedipine is a calcium ion influx inhibitor (slow-channel blocker or calcium ion antagonist) which inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle. The mechanism by which nifedipine reduces arterial blood pressure involves peripheral arterial vasodilatation and, consequently, a reduction in peripheral vascular resistance Nifedipine is a peripheral arterial vasodilator which acts directly on vascular smooth muscle The binding of nifedipine to voltage-dependent and possibly receptor-operated channels in vascular smooth muscle results in an inhibition of calcium influx through these channels. Nifedipine is a calcium channel blocker.
- Key words: calcium ion influx inhibitor, slow-channel blocker, calcium ion antagonist, peripheral arterial vasodilator. 2
From the Research
Types of Antihypertensive
Nifedipine is classified as a type of calcium channel blocker (CCB), specifically a dihydropyridine CCB 3, 4, 5.
Characteristics of Dihydropyridine CCBs
Dihydropyridine CCBs, such as nifedipine, are known for their effectiveness in reducing cardiovascular morbidity and mortality associated with uncontrolled hypertension, including stroke 3, 5.
Comparison with Other Antihypertensives
Compared to other antihypertensive agents, such as angiotensin-converting enzyme inhibitors and diuretics, dihydropyridine CCBs like nifedipine may be less effective in preventing heart failure and myocardial infarction 3, 5.
Suitability for Specific Patient Groups
Nifedipine and other dihydropyridine CCBs may be suitable for patients with certain comorbid conditions, such as:
Key Points
- Nifedipine is a dihydropyridine calcium channel blocker 3, 4, 5
- Effective in reducing cardiovascular morbidity and mortality associated with uncontrolled hypertension 3, 5
- May be less effective in preventing heart failure and myocardial infarction compared to other antihypertensive agents 3, 5
- Suitable for patients with certain comorbid conditions, such as isolated systolic hypertension, angina pectoris, and Raynaud's syndrome 3, 6, 7