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My pharmacology professor glossed over the mechanism that causes edema besides briefly discussing after/preload. If Calcium channel blockers and beta blockers both are negative ionotropes then why isn't heart failure some form of adverse effect in both drug classes?

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    Why do you think the mechanism is heart failure? Peripheral edema can be caused by other things, and in this case I believe it is.
    – Carey Gregory ♦
    Nov 7, 2022 at 23:37
  • Good point. I was hyper focused on heart failure as it is what we were learning in class. What other mechanism would the calcium channel blockers be using? Does it have something to do with the blocking of the channels in the blood vessels?
    – Justin Edward
    Nov 9, 2022 at 0:06
  • Consider what will happen if arteriolar resistance is decreased but resistance remains the same in the venous circulation. Or just google calcium channel blockers + edema and you will find this. Questions here are required to demonstrate prior research, so I recommend that you edit your question and add this link along with a relevant quote from the article.
    – Carey Gregory ♦
    Nov 9, 2022 at 0:17
  • Sorry I am new here. I didn’t mean to pose my question the wrong way.
    – Justin Edward
    Nov 9, 2022 at 0:43
  • That's okay, many new users do the same. Just follow my suggestions and you're good. Your question has upvotes so people think it's a good question.
    – Carey Gregory ♦
    Nov 9, 2022 at 1:43

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It has to do with different mechanism of action of both substances. Both calcium channel blockers and beta blockers are used to lower blood pressure, but the ways, how the hypotensive effect is achieved, are different.

As a first approximation, the arterial blood pressure PA evolves with

PA = PV + R * dV/dt,

where PV is central venous pressure, R is total peripheral resistance and dV/dt is cardiac output.

Calcium channel blockers have vasodilatory action, i.e. they lower R. Beta-blockers act mainly on the heart so that they decrease dV/dt. Both mechanisms lower blood pressure, but the ways are different.

Different are also their side effects. Beta-blockers may lead to bradycardia (and other problems), and calcium channel blockers increase the hydrostatic pressure in the precapillary circulation, thereby permitting fluid shifts into the interstitial compartment. Beta-blockers have even a slight vasoconstrictor effect.

This is the reason why patients on calcium channel blockers are more prone to oedema than persons on beta-blockers.

References

  1. Sica D. Calcium channel blocker-related periperal edema: can it be resolved? J Clin Hypertens (Greenwich). 2003 Jul-Aug;5(4):291-4, 297. doi 10.1111/j.1524-6175.2003.02402.x. PMID 12939574.

  2. Makani H, Bangalore S, Romero J, Htyte N, Berrios RS, Makwana H, Messerli FH. Peripheral edema associated with calcium channel blockers: incidence and withdrawal rate--a meta-analysis of randomized trials. J Hypertens. 2011 Jul;29(7):1270-80. doi 10.1097/HJH.0b013e3283472643. PMID 21558959.

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    Wow. Thank you!
    – Justin Edward
    Nov 13, 2022 at 17:03
  • @JustinEdward The thing to do would be to click the check mark to accept this answer.
    – Carey Gregory ♦
    Nov 14, 2022 at 15:53
  • Thank you! I didn't know that was a feature. I appreciate the help with both pharmacology and the website.
    – Justin Edward
    Nov 15, 2022 at 16:03

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