Congestive
cardiac failure is an increasingly prevalent syndrome associated with a high morbidity and mortality. The role of
calcium channel blockers in the treatment of
heart failure is unclear. The potential benefits of these agents derive not only from their
vasodilator properties, but also from anti-ischemic effects, beneficial effects on endothelial function and the development of
atherosclerosis, and favorable effects on
calcium cycling at a molecular level. Pitted against this array of potential benefits are direct negative inotropic effects and the potential for neuroendocrine activation. Treatment with short-acting
dihydropyridine agents has not resulted in long-term clinical benefits in patients with
cardiac failure.
Diltiazem may be beneficial in patients with nonischemic
heart failure, and
verapamil has a neutral effect in
cardiac failure, although it may have a role in combination with ace inhibition. To date,
amlodipine has been associated with the most promising results, with evidence of a mortality benefit in nonischemic
heart failure.
Mibefradil is of no benefit in the management of
heart failure, although the trend toward increased mortality in the treatment arm of the Mortality Assessment in
Congestive Heart Failure (MACH)-1 trial may have been due to drug interactions. The potential role of
calcium blockers in diastolic dysfunction and in combination with ace-inhibition requires further study.