Calcium entry blocking drugs, 'calcium antagonists' and vascular smooth muscle function.

The group of drugs known as "calcium antagonists' is under extensive investigation in experimental animals and man and a re-evaluation of their pharmacological properties is overdue. Recent proposals to adopt the more specific nomenclature of calcium entry blockers for some of these compounds (Vanhoutte & Bohr, 1981) should be supported since there is much confusion in the literature with this class of compound. In this review, which concentrates on vascular smooth muscle, only nifedipine, verapamil, their close chemical analogues and diltiazem are recognised as being relatively selective calcium entry blocking drugs. Whilst definitive evidence for calcium entry blockade must include the demonstration of a selective inhibition of Ca2+-influx into a tissue over a range of concentrations also inhibiting contraction, it is nevertheless possible to define several simple pharmacological criteria which may aid in the identification of such activity. These criteria include the selective antagonism of K+ and Ca2+-induced contractions, relative to those of noradrenaline in suitable vascular smooth muscle preparations and a selective inhibition of alpha 2- as opposed to alpha 1-adrenoreceptor mediated pressor responses in, for example, pithed rat preparations. Recent pharmacological and biochemical studies have identified 3 major subgroups of "calcium antagonist' drugs but the compounds within each subgroup varies with the technique adopted. It is therefore suggested that a combination of both pharmacological and ligand-binding studies be used for purposes of classification. Which mechanism, if any, of inhibiting calcium entry is therapeutically most desirable remains an important question for future research.