From the Guidelines
The efficacy of Calcium Channel Blockers (CCBs) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) should be evaluated with caution, as immediate-release nifedipine is not recommended for routine use due to increased mortality risk 1. When considering CCBs, it's essential to distinguish between dihydropyridines (e.g., nifedipine, amlodipine) and nondihydropyridines (e.g., diltiazem, verapamil), as they have different effects on contractility, atrioventricular conduction, and heart rate 1.
- Dihydropyridines cause marked peripheral vasodilation with little direct effect on contractility, atrioventricular conduction, and heart rate.
- Nondihydropyridines have significant negative inotropic actions and negative chronotropic and dromotropic effects. The scoring for CCB efficacy is not explicitly defined, but their effectiveness can be evaluated based on their ability to alleviate ischemia due to obstructive CAD by decreasing heart rate and blood pressure 1.
- Verapamil and diltiazem have been shown to decrease reinfarction in patients without left ventricular dysfunction in some studies 1.
- However, immediate-release nifedipine is associated with a dose-related increase in mortality in patients with CAD and harm in ACS, making it not recommended for routine use 1. In general, CCBs are preferred in vasospastic angina, and long-acting preparations may be useful in older patients with systolic hypertension 1. It's crucial to weigh the benefits and risks of CCBs in individual patients, considering factors such as left ventricular function, blood pressure, and concomitant medications 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Scoring for Calcium Channel Blocker (CCB) Efficacy
The efficacy of Calcium Channel Blockers (CCBs) can be evaluated based on their ability to reduce cardiovascular morbidity and mortality associated with uncontrolled hypertension.
- CCBs have been shown to reduce the risk of stroke and cardiovascular events, and decrease mortality compared to placebo 2, 3, 4.
- However, CCBs appear to be less effective than angiotensin-converting enzyme inhibitors and diuretics in preventing heart failure and myocardial infarction 2.
- The efficacy of CCBs can also be evaluated based on their ability to lower blood pressure, with a goal of reducing overall blood pressure to below 140/90 mmHg, and a more optimal goal of 130/80 mmHg 5.
- CCBs can be separated into two classes: dihydropyridine and non-dihydropyridine, which have different mechanisms of action and efficacy profiles 5, 6.
- Long-acting CCBs have been shown to be effective and safe in the treatment of hypertension, and can be used as alternatives to ACE inhibitors in patients with hypertension and concomitant diabetes mellitus, renal disease, Raynaud's phenomenon or migraine 4, 6.
Comparison of CCB Efficacy with Other Antihypertensive Agents
- CCBs have been compared to other antihypertensive agents, including angiotensin-converting enzyme inhibitors, diuretics, and beta-blockers, in terms of their efficacy in reducing cardiovascular events and mortality 2, 3, 4.
- The results of these comparisons suggest that CCBs are generally effective in reducing cardiovascular events and mortality, but may have different efficacy profiles compared to other antihypertensive agents 2, 3, 4.
- Combination therapy with CCBs and other antihypertensive agents, such as angiotensin receptor blockers or angiotensin-converting enzyme inhibitors, has been shown to be an effective dual therapy based on recent meta-analyses 5.