Question:hard

Cilnidipine is unique among dihydropyridine calcium channel blockers in not causing reflex tachycardia. This is because, in addition to L-type channels, it also blocks which type of voltage-gated calcium channel located on sympathetic nerve endings?

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N-type channels on sympathetic terminals control noradrenaline release.
Updated On: Jun 25, 2026
  • T-type
  • R-type
  • N-type
  • L-type
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The Correct Option is C

Solution and Explanation

Reflex tachycardia from a calcium antagonist is a baroreflex response: vasodilation lowers pressure, baroreceptors fire less, and sympathetic outflow rises, releasing noradrenaline that speeds the heart. The release of noradrenaline at sympathetic terminals is gated by $N$-type voltage-gated calcium channels.

Cilnidipine is a dual $L/N$-type blocker. Its $L$-type action relaxes vascular smooth muscle to lower BP, while its $N$-type action at the sympathetic nerve ending suppresses the very noradrenaline release that would otherwise drive the reflex heart-rate rise:

$N\text{-type blockade} \Rightarrow \downarrow \text{noradrenaline release} \Rightarrow \text{no reflex tachycardia}$

T-type and R-type channels are not the sympathetic-terminal target responsible for this benefit.
\[\boxed{\text{Cilnidipine additionally blocks N-type Ca}^{2+}\text{ channels}}\]
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