Differential effects of calcium-channel blockers on vascular endothelial function in patients with coronary spastic angina.

Abstract

BACKGROUND:

The effects of the 3 classes of L-type calcium-channel blockers (CCBs) on vascular endothelial function have not been clarified in patients with coronary vasospasm.

METHODS AND RESULTS:

Twenty-five normotensive patients (age 64.0+/-1.4 years) with coronary vasospasm were randomly treated for 3 months with benidipine, diltiazem, and verapamil, which belong to the dihydropyridine, benzothiazepine, and phenylalkylamine classes of CCBs, respectively. Endothelium-dependent flow-mediated dilatation (FMD), endothelium-independent nitroglycerin-induced dilatation in the brachial arteries, and plasma cyclic guanosine 3',5'-monophosphate (cGMP), a nitric-oxide-related product, were assessed before and after treatment. At baseline, the patients with vasospasm had significantly lower FMD as compared with normal subjects (n=8). Blood pressure did not differ among the 3 groups before and after treatment. Benidipine significantly increased FMD (from 4.7+/-0.6 to 7.4+/-1.1%, P<0.05) and plasma cGMP levels. In contrast, neither diltiazem nor verapamil affected FMD and cGMP levels. None of the treatments affected nitroglycerin-induced dilatation.

CONCLUSIONS:

Benidipine, but not diltiazem or verapamil, improves endothelial dysfunction beyond blood pressure lowering effects in patients with coronary vasospasm. Upregulation of the nitric oxide - cGMP system by benidipine may partly contribute to the improvement. The dihydropyridine class may be more beneficial for vascular endothelial function than the non-dihydropyridine classes of CCBs.

• Authors: Yoichi Miwa, Hiroyuki Masai, Masatoshi Shimizu
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 73 Issue 4 Pg. 713-7 (Apr 2009) ISSN: 1346-9843 [Print] Japan
• PMID: 19225210 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Calcium Channel Blockers
• Dihydropyridines
• benidipine
• Verapamil
• Diltiazem

Topics

• Aged
• Blood Pressure (drug effects)
• Calcium Channel Blockers (administration & dosage, therapeutic use)
• Coronary Vasospasm (drug therapy, physiopathology)
• Dihydropyridines (administration & dosage, therapeutic use)
• Diltiazem (administration & dosage, therapeutic use)
• Endothelium, Vascular (physiopathology)
• Female
• Humans
• Male
• Middle Aged
• Vasodilation (drug effects)
• Verapamil (adverse effects, therapeutic use)