High blood pressure is one of the most common health problems in the world. It puts extra strain on the heart and blood vessels and, if it is not controlled, can increase the risk of heart attack, stroke, kidney disease, and heart failure.
Doctors have several types of medicines available to lower blood pressure. One widely used group is known as L-type calcium channel blockers, which includes drugs commonly prescribed to people whose blood pressure remains too high.
These medicines lower blood pressure by affecting calcium movement in the muscle cells that surround blood vessels. Calcium helps these cells tighten, so blocking some calcium from entering them allows blood vessels to relax and widen.
This makes it easier for blood to flow and usually lowers pressure inside the arteries. However, research from Penn State and other institutions suggests that the long-term effects of these drugs on blood vessels may be more complicated than previously thought.
The study was led by Mohamed Trebak and colleagues and was published in the Proceedings of the National Academy of Sciences, commonly known as PNAS. The researchers examined how calcium channel blockers affect the muscle cells in blood vessel walls.
These cells normally tighten and relax to help control blood flow. In people with long-term high blood pressure, the cells can change, causing artery walls to become thicker and less flexible.
This process can make it harder for the heart to pump blood through the body. Over time, the extra workload can contribute to heart damage and eventually heart failure.
Calcium channel blockers were expected to help prevent some of these harmful changes because they reduce calcium entering the muscle cells. But the researchers found that blocking these channels for long periods could activate another biological process that may encourage unwanted changes in the blood vessels.
The team studied blood vessel cells in laboratory experiments and also performed experiments in rats. They found evidence that long-term blocking of L-type calcium channels could cause changes in the cells that resemble those seen when blood vessels become unhealthy.
The scientists then examined patient information from Penn State’s medical records. Their analysis found an association between treatment with L-type calcium channel blockers and a higher occurrence of heart failure compared with some other blood pressure treatments.
However, this type of medical-record analysis cannot prove that the medicines caused heart failure. People prescribed different blood pressure drugs can differ in age, health, disease severity, and other factors that may influence their risk.
The findings therefore should not be taken to mean that calcium channel blockers are unsafe for everyone. These medicines are well-established treatments for high blood pressure and other cardiovascular conditions, and lowering dangerously high blood pressure can prevent serious complications.
The study instead raises questions about what may happen inside blood vessels during long-term treatment. The researchers suggested that more work is needed to determine which patients might face greater risk and whether some alternative medicines could be preferable in certain situations.
The researchers also discussed possible concerns for people with high blood pressure who develop COVID-19 because the disease can affect blood vessels. However, more evidence is needed to understand whether calcium channel blockers meaningfully change COVID-related risks.
People taking these medicines should not stop them because of this research. Suddenly changing blood pressure treatment without medical advice can cause blood pressure to rise and may create much more immediate health risks.
Anyone concerned about a calcium channel blocker can discuss the benefits and risks with their doctor. The study adds another piece to scientists’ understanding of hypertension and shows why researchers continue to investigate how blood pressure medicines affect the heart and blood vessels over many years.
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