A 60-year-old man with ischemic heart failure (ejection fraction 30%) requires an antihypertensive addition to his guideline-directed medical therapy. Which calcium channel blocker can be used without worsening his prognosis?
- A Verapamil
- B Diltiazem
- C Amlodipine ✓
- D Nifedipine immediate release
Correct answer: C. Amlodipine
Explanation
Trials such as PRAISE showed amlodipine is prognostically neutral in HFrEF, making it the only dihydropyridine acceptable when a CCB is truly needed in heart failure. Verapamil and diltiazem depress contractility and worsen decompensated failure. Immediate-release nifedipine causes reflex sympathetic activation and has been associated with harm in coronary disease. Long-acting dihydropyridines avoid negative inotropy because vascular selectivity limits cardiac depression.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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