Actions of nisoldipine in cardiovascular disease.

The potent systemic and coronary vasodilatory properties of nisoldipine have been demonstrated in several studies in patients with cardiovascular disease. The increase in cardiac output results from enhancements of both stroke volume and heart rate, while coronary blood supply increases in excess of demand. There is evidence that nisoldipine favourably affects several indicators of myocardial ischemia during exercise such as time to onset of anginal complaints and ST segment changes. Furthermore, in patients with elevated left ventricular filling pressures and reduced cardiac pump function the drug tends to normalize these parameters, thus opening new avenues for the treatment of patients with heart failure. The effect of nisoldipine on the incidence of ventricular arrhythmias has not yet been studied in patients, but experimental evidence shows an antifibrillatory activity at doses which may, however, not be clinically applicable. Finally, in healthy men, nisoldipine partially inhibits platelet aggregation. This, together with a potential antiatherosclerotic effect, could be of additional benefit to patients with coronary artery disease.