Calcium Antagonists in the Treatment of Individuals with Ischemic Heart Disease

The so-called calcium antagonists—verapamil, nifedipine, diltiazem, and perhexiline—are pharmacologic agents that will have a dramatic impact on the medical therapy of individuals with ischemic heart disease. They have been used extensively in Europe and Japan for over 15 years, and more recent studies from this country have demonstrated their efficacy in the treatment of patients with Prinzmetal's “variant” angina pectoris, stable (exertional) an gina pectoris, and unstable angina pectoris. In addition, they appear effective in protecting ischemic myocardium both in patients with acute myocardial infarction as well as in those undergoing cardiopulmonary bypass. The purpose of this review is twofold: (a) to describe the mechanism of action and phar macology of these agents and (b) to delineate their role in the treatment of individuals with ischemic heart disease.