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European Heart Journal 1997 18(Supplement A):56-70; doi:10.1093/eurheartj/18.suppl_A.56
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European Society of Cardiology

Major differences among the three classes of calcium antagonists

R. Ferrari

chair of Cardiology, University of Brescia; Salvatore Maugeri Foundation, IRCCS, Cardiovascular Pathophysiology Research Center Gussago, Brescia, Italy

Correspondence: Prof. Roberto Ferrari, Chair of Cardiology, University of Brescia, Spedali Civili, P.le Spedali Civili, 1, 25123 Brescia, Italy

The safety of calcium antagonists has recently become a controversial issue among cardiologists. Thus, the role of calcium antagonists in the treatment of myocardial infarction and in secondary cardiovascular prevention is under review. As a consequence, the concept that the words ‘calcium antagonists’ comprise various drug classes has re-emerged. These differ in basic pharmacological properties, tissue selectivity, pharmacokinetics, and final haemodynamic effect. Obviously, such differences alter their therapeutic effect.

In this article, the major differences among the three classes of calcium antagonists, phenylalkylamines, dihydropyridines and benzothiazepines, are discussed and reviewed. A comparative analysis of available clinical trials focusing on the usefulness of each drug class is provided for the reader's interest. Some particularly relevant pathological conditions are considered: chronic stable angina pectoris, vasospastic angina, unstable angina pectoris with threatened myocardial infarction, myocardial infarction, and congestive heart failure.

Key Words: Calcium antagonists • angina pectoris • myocardial infarction • congestive heart failure


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