Calcium Antagonism and the Ischaemic Heart: Is Calcium Antagonism Relevant?

Abstract

Having established that the calcium antagonists, including vascular selective calcium antagonists such as amlodipine, have a favourable effect on renal haemodynamics and function (Chapter 10), and before considering their usefulness as blood pressure lowering agents — particularly with respect to their long term use in the management of patients with essential hypertension (Chapter 14), the logical question which emerges now concerns the feasibility of using calcium antagonists to protect the ischaemic myocardium. The next three chapters (Chapters 11–13) and Chapter 16 address this problem. Firstly, however, it is necessary to consider the laboratory data which indicates that these drugs can protect against the consequences of artificially-induced ischaemia. Only then is it relevant to consider the available data pursuant to the use of these drugs in the management of patients with naturally-occurring ischaemic heart disease. There are two major reasons why discussion on this topic should be included here, even though the clinical management of patients with ischaemic heart disease is currently undergoing massive changes in strategy, with new “protective” regimes being devised and new criteria for diagnosis being developed.

“To be or not to be — that is the question.”

William Shakespeare in “Hamlet”