How does Ranolazine (generic name) affect blood pressure in patients with chronic angina?

Ranolazine Has Minimal to No Effect on Blood Pressure

Ranolazine does not significantly affect blood pressure in patients with chronic angina, making it particularly valuable for patients with pre-existing hypotension or bradycardia who cannot tolerate traditional antianginal agents. 1, 2, 3

Hemodynamic Profile

Ranolazine maintains a neutral hemodynamic profile:

• Patients treated with ranolazine in controlled clinical studies had minimal changes in mean systolic blood pressure (<3 mm Hg) 3
• Mean heart rate changes were similarly negligible (<2 bpm) 3
• The antianginal effects occur without dependence on reductions in heart rate or blood pressure 1, 3
• Ranolazine does not affect the rate-pressure product (a measure of myocardial work) at maximal exercise 3

Clinical Advantages in Specific Populations

This neutral hemodynamic profile provides distinct clinical advantages:

• Ranolazine is particularly useful in patients with bradycardia and/or hypotension who cannot tolerate beta-blockers or calcium channel blockers 1, 2
• The American College of Cardiology recommends ranolazine for patients with chronic stable angina who have inadequate symptom control with first-line agents, particularly in cases of bradycardia or hypotension 2
• Similar hemodynamic neutrality was observed across subgroups including patients with CHF NYHA Class I or II, diabetes, reactive airway disease, and elderly patients 3

Contrast with Traditional Antianginal Agents

This distinguishes ranolazine from traditional antianginal medications:

• Isosorbide dinitrate causes significant reduction in blood pressure and produces reflex tachycardia 2
• Beta-blockers and calcium channel blockers commonly cause hypotension and bradycardia, limiting their use in certain patients 2
• Ranolazine has minimal to no effect on blood pressure or heart rate across multiple studies 2, 4, 5, 6

Mechanism Underlying Hemodynamic Neutrality

• Ranolazine works through inhibition of the late sodium current (late INa), preventing intracellular calcium overload during ischemia without affecting vascular tone or cardiac contractility 1, 2
• This mechanism differs fundamentally from vasodilators and negative chronotropic/inotropic agents 1

Important Safety Consideration

• While ranolazine does not affect blood pressure, it does cause dose-related QT interval prolongation (approximately 2.6 msec per 1000 ng/mL plasma concentration), though torsades de pointes has not been observed at therapeutic doses 1, 3