MedTweetorial on CCBs! 👩⚕️ Dive into dihydropyridines vs. NONdihydropyridines.. A quick guide! 💊
DHPs (amlodipine, nifedipine) = 💪 potent vasodilators, may ⬆️HR.. NON-DHPs (diltiazem, verapamil) = ⬇️HR.
- HTN 💨? Consider amlodipine (long-acting, less ⬆️HR, 👍 more data for improving CV outcomes).
- HTN in pregnancy🤰? Nifedipine ER is your friend.
- HR control🚦in atrial fibrillation? Consider NON-DHPs; choose diltiazem over verapamil (less 💩 constipation).
- 🫀HF? ⚠️ Most CCBs off the table. Amlodipine might be OK if you must, after maxing out core HF meds.
- Mix DHP + NON-DHP? It's okay to combine them; save for rare cases only (e.g., CKD + resistant HTN).
- 🚨 SideFx & Interxs? DHPs = more edema 🦵vs. NON-DHPs. Don't rush to diuretics; try ⬇️dose or add ACEI/ARB. Avoid combination (diltiazem/verapamil + beta-blockers) ➡️ 🚫 bradycardia/heart block.
- CYP3A4? Manage interactions and adjust meds like colchicine/simvastatin.
References
- Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104.
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-1324.
- Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e876-e894.
