Faculty of Medicine, University of Nis, Nis, Serbia.
Department for Cardiovascular Diseases, University Clinical Center Nis, Nis, Serbia.
Med Princ Pract. 2022;31(5):454-462. doi: 10.1159/000526792. Epub 2022 Aug 31.
Arterial hypertension (HTN) is important due to its high prevalence, morbidity, and mortality rates. Calcium channel blockers (CCBs) are the first-line antihypertensive drugs. HTN can lead to heart failure (HF) by causing hypertensive left ventricular hypertrophy (HTN LVH). CCBs are recommended for the treatment of HTN LVH. The aim of this study was to analyze the status of CCBs regarding (1) HTN LVH treatment and (2) capability to prevent HTN-induced HF in the guidelines. For this narrative review, the following databases were searched: Medline, Scopus, Science Direct, Springer, SAGE, Wiley, Oxford Journals, Cambridge, and Google Scholar. CCBs are effective antihypertensive drugs and a very good therapeutic option for HTN LVH as they can cause reverse LVH remodeling. Consequently, we may expect that CCBs would prevent HF. However, evidence suggests that CCBs confer less protection from HF than other first-line antihypertensive drugs. A negative inotropic action of nondihydropyridine CCBs may contribute to suboptimal protection against HF. This discrepancy is clinically relevant because CCBs are in one of the two recommended (single pill) combinations for the initial treatment of HTN. LVH is a strong risk factor for HF in HTN patients. When LVH arises, the risk of HF increases dramatically. CCBs are inferior to renin-angiotensin-aldosterone system blockers but still very effective in bringing about regression of HTN LVH; consequently, CCBs are expected to protect from HF. On the contrary, CCBs protect from HF less effectively than other first-line antihypertensive drugs. This discrepancy needs to be investigated further to improve clinical practice.
动脉高血压（HTN）很重要，因为它的发病率、患病率和死亡率都很高。钙通道阻滞剂（CCB）是一线降压药。HTN 可导致高血压性左心室肥厚（HTN LVH），从而导致心力衰竭（HF）。推荐 CCB 治疗 HTN LVH。本研究旨在分析指南中（1）HTN LVH 治疗和（2）预防 HTN 引起 HF 的 CCB 应用情况。本综述采用叙述性方法，检索了 Medline、Scopus、Science Direct、Springer、SAGE、Wiley、Oxford Journals、Cambridge 和 Google Scholar 等数据库。CCB 是有效的降压药，也是 HTN LVH 的很好的治疗选择，因为它们可以引起 LVH 逆转重构。因此，我们可能期望 CCB 会预防 HF。然而，有证据表明 CCB 对 HF 的保护作用不如其他一线降压药。非二氢吡啶 CCB 的负性肌力作用可能导致对 HF 的保护作用不佳。这种差异具有临床意义，因为 CCB 是 HTN 初始治疗推荐的两种（单片）联合用药之一。LVH 是 HTN 患者 HF 的一个强烈危险因素。当 LVH 出现时，HF 的风险会急剧增加。CCB 不如肾素-血管紧张素-醛固酮系统阻滞剂，但仍能非常有效地使 HTN LVH 消退；因此，预计 CCB 会预防 HF。相反，CCB 对 HF 的保护作用不如其他一线降压药。需要进一步研究这种差异，以改善临床实践。
