Calcium Channel Blocking Agents and Nitrates

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The ability of other anti-ischemic drugs such as calcium channel blocking agents and nitrates to blunt potential triggering mechanisms is less clear. Two large studies

Fig. 15. In the Physician's Health Study, the significant (p < 0.001) morning increase among 211 nonfatal myocardial infarctions (top panel) was preserved in patients randomized to placebo (p < 0.001) (middle panel) and attenuated (p = 0.16) in patients randomized to aspirin, 325 mg every other day (bottom panel). Reprinted with permission from ref. 169.

Fig. 15. In the Physician's Health Study, the significant (p < 0.001) morning increase among 211 nonfatal myocardial infarctions (top panel) was preserved in patients randomized to placebo (p < 0.001) (middle panel) and attenuated (p = 0.16) in patients randomized to aspirin, 325 mg every other day (bottom panel). Reprinted with permission from ref. 169.

of the circadian variation in the time of onset of acute myocardial infarction identified a subset of patients taking calcium channel blockers and found a persistent morning increase in infarctions in these patients (27,35) (Fig. 14). On the other hand, some smaller trials reported the absence of a morning increase in infarction (159) and sudden cardiac death (164) in patients taking calcium channel blocking agents. Two subset analyses from trials reporting nitrate usage described no beneficial effect of this agent on the circadian variation of myocardial infarction onset (35,139). However, one study found that the lack of use of nitrates or calcium channel blockers in the 24 h prior to the onset of infarction was associated with a higher frequency of infarction during physical exertion (35).

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