Abstract
Calcium channel blockers decrease blood pressure in essential hypertension due to a marked reduction of systemic vascular resistance (arteriolar tone). They also dilate conducting arteries but have no venodilatory effect in antihypertensive doses. With the dihydropyridines (e.g. nifedipine) and diltiazem there is a transient increase in heart rate and cardiac output but this is not observed with verapamil. The vasodilatory responsiveness in the resistance vessels to calcium channel blockers is selectively enhanced in patients with established essential hypertension but not in the early borderline phase of hypertension. During treatment with chlorthalidone, atenolol, acebutolol or nitrendipine for four to six weeks the reduction of blood pressure is accompanied by a selective decrease in the vasodilatory responsiveness to calcium channel blockers.
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