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Calcium Channel Blockers in Acute Care: The Links and Missing Links Between Hemodynamic Effects and Outcome Evidence

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Abstract

Calcium channel blockers (CCBs) exert profound hemodynamic effects via blockage of calcium flux through voltage-gated calcium channels. CCBs are widely used in acute care to treat concerning, debilitating, or life-threatening hemodynamic changes in many patients. The overall literature suggests that, for systemic hemodynamics, although CCBs decrease blood pressure, they normally increase cardiac output; for regional hemodynamics, although they impair pressure autoregulation, they normally increase organ blood flow and tissue oxygenation. In acute care, CCBs exert therapeutic efficacy or improve outcomes in patients with aneurysmal subarachnoid hemorrhage, acute myocardial infarction and unstable angina, hypertensive crisis, perioperative hypertension, and atrial tachyarrhythmia. However, despite the clear links, there are missing links between the known hemodynamic effects and the reported outcome evidence, suggesting that further studies are needed for clarification. In this narrative review, we aim to discuss the hemodynamic effects and outcome evidence for CCBs, the links and missing links between these two domains, and the directions that merit future investigations.

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Acknowledgements

The authors would like to acknowledge the support received from institutional and departmental sources.

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Authors and Affiliations

  1. Department of Anesthesiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China

    Jin Wang

  2. Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA

    David L. McDonagh

  3. Department of Anesthesiology, Yale University School of Medicine, 330 Cedar Street, TMP 3, New Haven, CT, 06520, USA

    Lingzhong Meng

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JW helped conduct literature search, analyze the data, write the manuscript, and approve the final manuscript. DLM helped write and edit the manuscript and approved the final manuscript. LM helped conceptualize the topic, provided the observational data, wrote and edited the manuscript, and approved the final manuscript.

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Correspondence to Lingzhong Meng.

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Jin Wang, David L. McDonagh, and Lingzhong Meng have no potential conflicts of interest that might be relevant to the contents of this manuscript.

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Supplementary file2 Supplementary video An intravenous bolus of nicardipine 0.4 mg was administered to a patient undergoing laparoscopic hysterectomy. It led to a quick decrease in BP (black belt with the upper and lower edges as systolic and diastolic BP and the red line within as the mean BP) and SVR (green belt). HR (pink tracing and pink numbers) and SV (blue numbers) are both mildly increased. As a result, cardiac output increased (not shown). Hemodynamics were monitored using a LiDCO monitor (LiDCO Group, London, UK). BP blood pressure, HR heart rate, SV stroke volume, SVR systemic vascular resistance (MOV 67126 kb)

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Wang, J., McDonagh, D.L. & Meng, L. Calcium Channel Blockers in Acute Care: The Links and Missing Links Between Hemodynamic Effects and Outcome Evidence. Am J Cardiovasc Drugs 21, 35–49 (2021). https://doi.org/10.1007/s40256-020-00410-4

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