Treatment of hypertension Mild and moderate hypertension are the most common indications for calcium antagonists. In China, the main complication of hypertension is stroke, not myocardial infarction, so calcium antagonists are recommended as the first-line drug for the treatment of hypertension in the elderly. The biggest advantage of calcium antagonists is that they have mild side effects and are not resistant to long-term use. Long-acting calcium antagonists have stable and long-lasting antihypertensive effects, with significant efficacy, and are beneficial to the protection of the heart, kidney, brain and other organs, which can significantly reduce the incidence of cardiovascular and cerebrovascular diseases. In patients with diabetic nephropathy, the combination of long-acting calcium antagonists and angiotensin-converting enzyme inhibitors has a better renal protective effect. However, short-acting calcium antagonists, such as nifedipine, also have value. Sublingual or oral nifedipine tablets remain an easy and effective means of lowering blood pressure in patients who need to lower their blood pressure rapidly in a short period of time. It should be noted that a small number of patients with rapid heartbeat, flushing, and increased blood pressure instead of a decrease in blood pressure after nifedipine has been administered should be seen by a hospital quickly to prevent accidents. Treatment of coronary artery disease Calcium antagonists are commonly used in the treatment of coronary artery disease. However, they are not suitable for all kinds of coronary heart disease. Currently, calcium antagonists are mainly used for patients with variant angina, coronary artery disease combined with hypertension and most exertional angina; it is not suitable for the treatment of unstable angina and myocardial infarction. Variable angina is characterized by long episodes of angina, heavy chest pain during episodes, generally longer duration than exertional angina, and episodes mostly in quiet time, especially in the early morning. The occurrence of angina is mainly related to coronary artery spasm. Therefore, this group of patients is mainly treated with medication and interventional treatment (including coronary stent placement) is not advocated. Calcium antagonists dilate and decongest the coronary arteries and increase coronary blood flow, so they are the drugs of choice for variant angina pectoris. The short-acting preparation nifedipine is more effective in relieving coronary artery spasm and is listed as the drug of choice for the treatment of variant angina. If it is not effective, a second calcium antagonist, or another drug (such as an a-blocker) can be added. Exertional angina is angina that occurs when the patient is exerted or emotionally excited. Some studies have shown good results with amlodipine in the treatment of stable angina pectoris. Nevertheless, beta-blockers (e.g., betaxolol, atenolol) are preferred in patients with exertional angina, with the option or addition of calcium antagonists if they are not effective. Calcium antagonists may be preferred if combined with hypertension or if there are relative contraindications to β-blockers. For asymptomatic myocardial ischemic attacks, calcium antagonists are less effective than β-blockers. Therefore, calcium antagonists should also be used as second-line drugs. However, calcium antagonists can be the first choice when there are contraindications to the use of β-blockers. Acute myocardial infarction and unstable angina are collectively referred to as acute coronary syndrome, the onset of which is mainly related to unstable coronary plaque and rupture with thrombosis. Currently, calcium antagonists are not advocated for use in patients with acute coronary syndromes. Short-acting nifedipine may increase the incidence of myocardial infarction and mortality in patients with unstable angina. A new series of clinical studies has shown that nifedipine increases mortality in patients with myocardial infarction; verapamil also has no beneficial therapeutic effect in myocardial infarction and should be avoided. However, thioprostone and verapamil (isoptin), which can slow the heart rate, can be used selectively for the treatment of acute myocardial infarction. Treatment of hypertrophic cardiomyopathy Hypertrophic cardiomyopathy is asymmetric myocardial hypertrophy that occurs in the absence of a cause of myocardial hypertrophy (e.g., hypertension, prolonged heavy exercise). This disease is hereditary in general patients. Therefore, a thorough family examination should be performed as soon as it is detected. Verapamil is the most used drug in the treatment of hypertrophic cardiomyopathy. Verapamil improves several indicators in patients with hypertrophic cardiomyopathy without contraindications to its use. The use of short-acting nifedipine in the treatment of hypertrophic cardiomyopathy remains controversial. Currently, it is advocated for use in combination with beta-blockers or in patients with hypertrophic cardiomyopathy in whom verapamil is contraindicated. Treatment of cardiac insufficiency Due to the lack of evidence for the effectiveness of calcium antagonists in the treatment of heart failure, this class of drugs is not recommended for the treatment of heart failure. Considering the safety of dosing, most calcium antagonists should be avoided even for the treatment of hypertension or angina pectoris in such patients. Only the long-acting agents amlodipine and felodipine have been shown in clinical trials to be safe for long-term use, but they also do not improve patient survival. Treatment of arrhythmias Calcium antagonists are most effective in the treatment of paroxysmal tachycardia, including sinus tachycardia, supraventricular tachycardia, and idiopathic ventricular tachycardia. It is also effective in atrial fibrillation and atrial flutter. For tachyarrhythmias in combination with hypertension, calcium antagonists are more suitable. Among the commonly used drugs, verapamil is the most effective, followed by thiazepam, and nifedipine is basically ineffective. Treatment of cerebrovascular disease Calcium antagonists are mainly used in cerebrovascular disease to lower blood pressure, treat and prevent stroke, and directly dilate cerebral blood vessels to improve cerebral ischemia. Recent studies have found that the benefit of antihypertensive therapy in reducing stroke is significantly greater than the benefit in reducing myocardial infarction. However, the clinical effectiveness of calcium antagonists as neuroprotective agents during the acute phase of a stroke attack has not been demonstrated. Treatment of atherosclerosis Ca2+ is involved in all processes of atherosclerosis formation, so theoretically, calcium antagonists may have a beneficial effect on atherosclerosis formation and progression. A recent international clinical study also demonstrated that calcium antagonists have an anti-atherosclerotic effect. However, some studies have also shown that calcium antagonists have no significant effect on the atherosclerotic process. More evidence is needed to support the use of calcium antagonists for the treatment of atherosclerosis. Therefore, calcium antagonists cannot be used clinically against atherosclerosis at this time. Trivia Calcium antagonists Calcium antagonists are a class of drugs that selectively block the entry of calcium ions into the cell via the cell membrane at the cellular level, thereby reducing the intracellular calcium ion concentration. It mainly acts on the heart and blood vessels. At present, calcium antagonists can be divided into three generations according to their characteristics and duration of action: the first generation of calcium antagonists are short-acting preparations, whose representatives include nifedipine, verapamil, diltiazem, etc. At this stage, they are still the most commonly used antihypertensive drugs in China. These preparations need to be taken several times a day and can cause great fluctuations in blood pressure, which can cause reflex sympathetic excitation, leading to increased myocardial oxygen consumption and easily induce arrhythmia, and cannot effectively reduce the morbidity and mortality of cardiovascular diseases. The second generation of calcium antagonists are medium-acting preparations, divided into two subclasses. Class A is basically the first generation of calcium antagonists of the slow-release and controlled-release preparations, which are new dosage forms developed in the past 10 years or so, and its representative drugs are nifedipine controlled-release tablets, felodipine extended-release tablets, nifedipine extended-release tablets and so on. These drugs are taken once or twice a day, with a smooth 24-hour antihypertensive effect, which can avoid morning hypertension and help reduce the incidence of cerebrovascular disease, and side effects such as headache, redness and palpitations are also significantly reduced after taking the drug. class B is a new compound, whose representative drugs are nifedipine, nimodipine and nisoldipine. The third generation of calcium antagonists are long-acting agents, including amlodipine (Loxodipine), lacidipine and others. Studies have found that long-acting calcium antagonists can be used as basic antihypertensive drugs in patients with hypertensive disease with ischemic heart disease. Nowadays, more and more patients are using long-acting calcium antagonists for antihypertensive treatment.