Calcium Channel Blockers in Angina — Two Subclasses, Two Profiles
Module 4 · Visual Summary
Tissue Selectivity Splits the Class
Vascular-Selective
Dihydropyridines
  • Amlodipine is the prototype
  • Peripheral and coronary vasodilation
  • Minimal cardiac rate or conduction effect
  • Slow onset minimizes reflex tachycardia
Balanced Vascular and Cardiac
Non-Dihydropyridines
  • Verapamil, diltiazem
  • Vasodilation plus heart rate and conduction slowing
  • No reflex tachycardia
  • Verapamil has the most cardiac effect
Beta-Blocker Combination Rule
CombinationSafety
Beta-blocker + dihydropyridinePreferred
Beta-blocker + non-dihydropyridineContraindicated
Key Adverse Effects
Subclass-Specific Risks
Dihydropyridines: peripheral edema from arteriolar dilation without matching venodilation. Non-dihydropyridines: contraindicated in heart failure with reduced ejection fraction due to negative inotropy; amlodipine is safe in this population.