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arrow Anti-hypertensive drugs

Calcium Channel Blockers

29 October 2008
There are three major classes of CCBs (phenylalkylamines, dihydropyridines and benzothiazepines) with different characteristics and all are effective in lowering BP. With few exceptions, they have no undesirable metabolic effects and their safety profile in hypertension appears good. It has been reported that dihydropyridine CCBs are particularly effective in reducing cerebrovascular events. They have also been shown to be effective and safe in the treatment of isolated systolic hypertension in the elderly.

In the long-term treatment of hypertension, long-acting CCBs are preferred. Rapid onset, short-acting nifedipine should preferably be used in combination with a beta-blocker.

Adverse effects include initial tachycardia, headache, flushing and ankle oedema. Unlike other CCBs, verapamil may reduce heart rate and care should be exercised when used with beta-blockers.

The use of sublingual nifedipine should be discouraged.

CCBs Starting Dose Recommended Maximum Dose
Amlodipine 2.5 mg 10 mg
Diltiazem 90 mg 360 mg
Diltiazem SR 200 mg400 mg
Felodipine 2.5 mg 10 mg
Isradipine 5 mg 20 mg
Lacidipine 2 mg 6 mg
10 mg
20 mg
Nicardipine 30 mg 60 mg
Nifedipine 30 mg 60 mg
Nifedipine GITS 30 mg 90 mg
Nifedipine SR 40 mg 80 mg
Verapamil120 mg 480 mg
Verapamil SR 120 mg 480 mg

Table 14: CCBs commonly used for the treatment of hypertension in Malaysia.

Clinical Practice Guidelines on the Management of Hypertension

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