Mechanisms of pharmacologic intervention at the level of the calcium channel.

Calcium channels are large, complex membrane proteins that mediate transmembrane calcium currents. At least 2 kinds of calcium channels are found in heart muscle--the transient type and the long-lasting type. Calcium currents are modulated by diverse endogenous and exogenous factors including hormones, catecholamines, and calcium antagonists. Calcium antagonists act preferentially on vascular smooth muscle and have relatively less effect on the calcium channels of heart muscle. Compared with heart muscle, vascular smooth muscle is relatively depolarized, suggesting that vascular smooth muscle cells have predominantly the long-lasting type of calcium currents. The differential binding to different types of calcium channels underlies the clinical efficacy of the calcium antagonists. A drug such as bepridil, which acts preferentially on the coronary vasculature rather than on the peripheral vasculature, dilates the coronary vessels without depressing cardiac contraction, a putative clinical advantage.