Which calcium channel blocker can be safely continued in a patient with heart failure with reduced ejection fraction who also needs treatment for hypertension?

• A Verapamil
• B Diltiazem
• C Nicardipine given twice daily
• D Amlodipine ✓

Explanation

Non-dihydropyridine calcium channel blockers verapamil and diltiazem depress cardiac contractility and slow AV conduction, worsening systolic heart failure, so they are contraindicated in reduced ejection fraction. Among dihydropyridines, amlodipine has neutral hemodynamic effects in heart failure trials such as PRAISE, making it the safest choice when a CCB is unavoidable. Nicardipine is also a dihydropyridine but amlodipine is the agent with specific trial evidence of safety in HFrEF and once-daily dosing suited to chronic therapy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.