Efficacy and safety of calcium channel blockers in heart failure: Focus onrecent trials with second-generation dihydropyridines

Background Chronic heart failure (CHF) has high morbidity and mortality rat es despite treatment with angiotensin-converting-enzyme inhibitors, diureti cs, and digoxin. Adjunctive-vasodilation through calcium channel blockade h as been suggested as potentially useful, However, the first-generation calc ium channel blockers, including the dihydropyridine nifedipine, showed disa ppointing results in CHF. The second-generation dihydropyridines were expec ted to be of more value, and of all the calcium channel blockers, these dru gs were the ones most studied in patients with CHF. Methods and Results The Medline databank was used to search studies in huma n beings (published in 1990 or later) that used dihydropyridines in patient s with CHF. The references of the studies found were subsequently checked f or additional data. In 17 studies and more than 2000 patients with CHF,no c onsistent beneficial effect was observed with regard to exercise tolerance and functional capacity, whereas plasma neurohormones were not affected. On the other hand, in general, no worsening of CHF was seen with these second -generation dihydropyridines, Two larger studies (PRAISE and V-HeFT III) ha ve given some estimates on the long-term effects-of dihydropyridines, and n o overall influence on mortality rate was: found. Of note, subanalysis of t he PRAISE study has suggested that in patients with a nonischemic cause of CHF, amlodipine might have a beneficial effect on survival. Conclusions In this review we have focused on the efficacy and safety Of di hydropyridines in patients with CHF, as reported in recent trials. The data do not support the use of dihydropyridines when primarily given as treatme nt for CHF. The results,:however, suggest that these drugs can be safely gi ven to patients:with left ventricular dysfunction or CHF who need additiona l treatment for angina pectoris or hypertension.