Metabolic Effects

As a group, the calcium channel blockers have few metabolic effects that are clinically deleterious.^7.8 Unlike the beta blockers and diuretics, calcium channel blockers do not adversely affect insulin secretion, blood glucose levels, or plasma lipoprotein levels. In addition, calcium channel blockers also do not affect potassium or magnesium balances.

Oral nifedipine may produce a transient increase in plasma renin levels, an effect not seen with diltiazem or verapamil.^8-10 Diltiazem and verapamil do not usually influence plasma norepinephrine levels, unlike nifedipine, which has been shown to increase plasma norepinephrine levels after a single dose; with extended use of nifedipine, however, these catecholamine spikes tend to normalize.¹⁰ Diltiazem, verapamil, and nifedipine all attenuate the pressor effect of norepinephrine (which may account for their effectiveness in the management of hypertensive emergencies) and transiently block the pressor effect of angiotensin II (which may contribute to their acute antihypertensive activity). ⁸

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