Calcium Channel Blockers (CCB)

Mechanism of Action

  • Inhibits transmembrane calcium influx (prevents calcium from entering cells) in cardiac (heart) and vascular smooth muscle (blood vessel walls). This causes vasodilation and lower resting blood pressure.
  • Some calcium channel blockers slow heart rate, which can further reduce blood pressure, relieve chest pain (angina) and control an irregular heartbeat.

Treatment

  • Angina pectoris
    • Coronary artery spasm (Peel & Mossberg 1995)
  • Supraventricular Arrhythmias (Peel & Mossberg 1995)
  • Hypertension

Names

  • Diltiazem (Cardizem)
  • Nifedipine (Procardia)
  • Verapamil (Isoptin, Calan)
  • Amlodipine (Norvasc)

Effect on Exercise and Rest

  • Decrease, increase or no effect on heart rate (Niedfeldt 2002)
  • Increase or no effect on stroke volume (Niedfeldt 2002)
  • Decrease or no effect on cardiac output (Niedfeldt 2002)
  • Decrease in vascular resistance (Niedfeldt 2002)
  • Increase or no effect on plasma volume (Niedfeldt 2002)

Nondihydropyridines (non-DHP)

  • Effect on exercise and rest
    • Decrease blood pressure during exercise (ACSM 2014)
    • Minor impairment of maximum heart rate (Niedfeldt 2002)
    • No change in exercise performance and endurance (ACSM 2014)
      • Responses can be variable (ACSM 2014)
    • Decreased left ventricular contractility (Niedfeldt 2002)
    • Constipation (Niedfeldt 2002)
  • Diltiazem (Cardizem, Dilacorxr)
    • No change in cardiac output during exercise (ACSM 2014)
    • Decrease heart rate in patients with hypertension (ACSM 2014)
  • Verapamil (Calan, Isoptin)
    • Decrease heart rate in patients with hypertension (ACSM 2014)

Dihydropyridines

  • Nifedipine, Nicardipine, Felodipine, Amlodipine
  • This class can be identified by the "-dipine" suffix.
  • Effect on exercise and rest
    • Decrease BP during exercise (ACSM 2014)
      • Greater decrease than non-DHP
    • No change in exercise performance and endurance (ACSM 2014)
      • Responses can be variable (ACSM 2014)
    • No change in heart rate during exercise (ACSM 2014)
    • Reflex tachycardia (Niedfeldt 2002)
    • Fluid retention (edema) (Niedfeldt 2002)
    • Vascular headaches (Niedfeldt 2002)
  • Amlodipine (Norvasc)
  • Aranidipine (Sapresta)
  • Azelnidipine (Calblock)
  • Barnidipine (HypoCa)
  • Benidipine (Coniel)
  • Cilnidipine (Atelec, Cinalong, Siscard)
  • Clevidipine (Cleviprex)
  • Efonidipine (Landel)
  • Felodipine (Plendil)
  • Isradipine (DynaCirc, Prescal)
  • Lacidipine (Motens, Lacipil)
  • Lercanidipine (Zanidip)
  • Manidipine (Calslot, Madipine)
  • Nicardipine (Cardene)
  • Nifedipine (Procardia, Adalat)
    • Increase of heart rate during rest
    • Increase of blood pressure during rest
    • No change in cardiac output during exercise (ACSM 2014)
    • Decreased stroke volume during exercise (ACSM 2014)
    • No change in heart rate during exercise (ACSM 2014)
  • Nilvadipine (Nivadil)
  • Nimodipine (Nimotop)
    • Passes the blood-brain barrier
    • Used to prevent cerebral vasospasm
  • Nisoldipine (Baymycard, Sular, Syscor)
  • Nitrendipine (Cardif, Nitrepin, Baylotensin)
  • Pranidipine (Acalas)

Recommended Populations

  • Recommended to black patients or those with asthma (Niedfeldt 2002)

Banned Status

  • None

References

American College of Sports Medicine (2013). Guidelines for Exercise Testing and Prescription, William & Wilkins, 9, 401.

Niedfeldt MW (2002). Managing Hypertension in Athletes and Physically Active Patients. Am Fam Physician. 1;66(3):445-453.

Peel C, Mossberg KA (1995). Effects of cardiovascular medication on exercise responses. Phys Ther. 75387-396.1.

Massie BM (1998) The safety of calcium-channel blockers. Clin Cardiol. 21(12 Suppl 2):II12-7.

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