Calcium-channel blockers for combined systemic hypertension and myocardial ischemia.

Scientific rationale suggests a potentially important role for the calcium-channel blockers in the treatment of patients with coexisting systemic hypertension and coronary artery disease. Clinical investigation confirms the usefulness of these drugs as monotherapy in the treatment of patients with chronic stable angina and mild-to-moderate hypertension. There are several therapeutic effects of the calcium-channel blockers in coronary artery disease. Beneficial actions on the major determinants of oxygen consumption, i.e., heart rate, blood pressure, and contractility, are generally seen. The potent coronary vasodilating actions of these drugs allow for increased coronary blood flow and alleviation of coronary vasospasm. The effectiveness of the calcium-channel blockers in hypertension appears to be primarily due to their ability to induce systemic vasodilation. Improvements in ventricular compliance, regression of left ventricular hypertrophy, and cardioprotection appear to be additional beneficial effects of the drugs. Calcium-channel blockers compare favorably with beta-blockers; they appear to be more effective than some beta-blockers in the treatment of hypertension in the elderly and black population and can be given to patients with bronchospasm or peripheral vascular disease. Calcium-channel blockers are a welcome addition to existing drug regimens available for the management of patients with concomitant coronary artery disease and systemic hypertension.