Calcium channel blockers related to best outcomes in vasospastic angina

"Nifedipine, diltiazem, and amlodipine are potent for VSA reduction; however, tailoring specific CCBs' adverse reactions to patient condition and the drug preparation would benefit the outcome," the researchers wrote.

The systematic review found that diltiazem would be most beneficial in patients with normal blood pressure control and elevated heart rate tendency. Patients with high blood pressure and decreased heart rate tendency benefit most from nifedipine. Also, diltiazem R two times per day and nifedipine CR once daily are not only effective in increasing patient compliance but also effective in surprising the early morning VSA symptoms. Amlodipine showed some benefits in VSA suppression but required further investigation.

Coronary artery vasospasm is an abnormal spasm of coronary arteries leading to transient or complete occlusion without exertion. It causes stable angina to acute coronary syndrome (ACS). However, calcium channel blockers can prevent this by suppressing Ca2+ influx into the vascular muscle cells. Nevertheless, the adverse effects of several CCBs' are harmful to these patients. The selection of the right CCBs would give the best clinical practice.

Against the above background, Jaspal Singh and colleagues from Indonesia conducted a systematic review to determine which CCBs (amlodipine, diltiazem or nifedipine) gives the best clinical outcomes concerning side effects and symptom relief. The review may aid healthcare workers in choosing which CCBs be used when a patient is presented with vasospastic angina.

For this purpose, the researchers obtained studies from four major medical databases through various keywords. Inclusion and exclusion were implemented as adults>18 years, English language, observational study, and drug of interest. Duplicates were eliminated, and the reviewal of the remaining studies was done.

The researchers reported the following findings:

• The search yielded 1378 articles. Six studies were, however, selected after implementing the study criteria.
• Diltiazem decreased angina and increased quality of life until the 12th week of treatment; however, some adverse effects, including atrioventricular block and recurrent angina up till the 4th week, were found.
• Nifedipine decreased vasospastic angina by the fourth and eighth weeks of treatment. Nevertheless, it caused an excessive drop in BP and increased heart rate by the eighth week.
• Slow-release preparation of both CCBs was found to increase efficacy and compliance.
• Amlodipine was also found to decrease VSA by 17%±140% and 33% after six weeks, but further studies are needed.

"We conclude that major CCBs such as amlodipine, nifedipine, and diltiazem are potent agents for decreasing VSA symptoms. However, the drug preparation and adverse reaction may change the overall outcome of the treatment," the researchers wrote.

Reference:

Singh J, Elton A, Kwa MComparison of various calcium antagonist on vasospastic angina: a systematic reviewOpen Heart 2023;10:e002179. doi: 10.1136/openhrt-2022-002179