Differential Effects of Calcium-Channel Blockers on Vascular Endothelial Function in Patients With Coronary Spastic Angina
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概要
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Background: The effects of the 3 classes of L-type calcium-channel blockers (CCBs) on vascular endothelial function have not been clarified in patients with coronary vasospasm. Methods and Results: Twenty-five normotensive patients (age 64.0±1.4 years) with coronary vasospasm were randomly treated for 3 months with benidipine, diltiazem, and verapamil, which belong to the dihydropyridine, benzothiazepine, and phenylalkylamine classes of CCBs, respectively. Endothelium-dependent flow-mediated dilatation (FMD), endothelium-independent nitroglycerin-induced dilatation in the brachial arteries, and plasma cyclic guanosine 3,5-monophosphate (cGMP), a nitric-oxide-related product, were assessed before and after treatment. At baseline, the patients with vasospasm had significantly lower FMD as compared with normal subjects (n=8). Blood pressure did not differ among the 3 groups before and after treatment. Benidipine significantly increased FMD (from 4.7±0.6 to 7.4±1.1%, P<0.05) and plasma cGMP levels. In contrast, neither diltiazem nor verapamil affected FMD and cGMP levels. None of the treatments affected nitroglycerin-induced dilatation. Conclusions: Benidipine, but not diltiazem or verapamil, improves endothelial dysfunction beyond blood pressure lowering effects in patients with coronary vasospasm. Upregulation of the nitric oxide - cGMP system by benidipine may partly contribute to the improvement. The dihydropyridine class may be more beneficial for vascular endothelial function than the non-dihydropyridine classes of CCBs.
- 社団法人 日本循環器学会の論文
- 2009-03-20
著者
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Shimizu Masatoshi
Departments of Cardiology, Kobe National Hospital
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Shimizu Masatoshi
Department Of Cardiology National Hospital Organization Kobe Medical Center
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Shimizu Masatoshi
Department Of Agricultural Chemistry Faculty Of Agriculture Niigata University
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Masai Hiroyuki
Department of Cardiology Kobe University Hospital
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Miwa Yoichi
Department Of Internal Medicine National Hospital Organization Kobe Medical Center
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Miwa Yoichi
Department Of Environmental Technology And Urban Planning Shikumi College Graduate School Of Enginee
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Masai Hiroyuki
Department Of Cardiology National Hospital Organization Kobe Medical Center
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