Which calcium channel blocker should be avoided as sole therapy in chronic stable angina because its rapid vasodilation produces reflex sympathetic activation and tachycardia that can worsen myocardial oxygen demand?

• A Verapamil
• B Diltiazem
• C Short-acting nifedipine ✓
• D Amlodipine

Explanation

Short-acting nifedipine drops peripheral resistance abruptly, triggering baroreceptor-mediated reflex tachycardia that increases cardiac workload and can precipitate ischemia. Verapamil and diltiazem slow AV conduction and reduce heart rate, while amlodipine has a slow onset that blunts reflex activation. This is why short-acting dihydropyridines are not used as monotherapy in angina, though long-acting formulations combined with a beta-blocker are acceptable.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

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