Document Detail

1995: the year of the calcium antagonist controversy.
MedLine Citation:
PMID:  8737855     Owner:  NLM     Status:  MEDLINE    
The year 1995 has been an unsettling one in the history of the treatment of hypertension and ischemic heart disease. A fierce debate has sprung up about the safety of calcium antagonists, particularly the dihydropyridine nifedipine. A widely publicized case-control study showed that compared with diuretics and beta-blockers, short-acting calcium antagonists, when used in the treatment of hypertension, were associated with a higher risk of myocardial infarction, an effect which appeared to be dose related. A second study focused on clinical trials of nifedipine in patients primarily with acute myocardial ischemia syndromes. The meta-analysis showed an increased risk in the relative mortality rate of 1.16 associated with the use of short-acting nifedipine at doses of 80 mg/day or higher. The mechanisms responsible for these results were also discussed. Both publications were accompanied by editorials, and there were subsequently other commentaries published which pointed out weaknesses in the design, conduct, analysis and interpretation of the studies, and these have also been reviewed. Arising from this controversy, important questions have been raised which need to be addressed. First, are the data valid and are these drugs safe? If not, can the data be extrapolated from short-acting dihydropyridines, to the newer formulations and other sub-classes of calcium antagonists? Second, do these agents reduce cardiovascular morbidity and mortality? Finally, what are the alternatives to their use and the clinical implications? These studies have raised questions about safety, and there is little evidence to show any actual benefit on the incidence of cardiovascular events. For most patients there are clinically tested and proved therapeutic alternatives, i.e. diuretics and beta-blockers, and therefore the burden of proof must now be on those who primarily recommend the use of calcium antagonists. Recommendations and guidelines for treatment, where the primary goal is to reduce cardiovascular morbidity and mortality must be supported by adequate data.
J D Cohen
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in nephrology and hypertension     Volume:  5     ISSN:  1062-4821     ISO Abbreviation:  Curr. Opin. Nephrol. Hypertens.     Publication Date:  1996 May 
Date Detail:
Created Date:  1996-12-09     Completed Date:  1996-12-09     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9303753     Medline TA:  Curr Opin Nephrol Hypertens     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  214-8     Citation Subset:  IM    
Department of Internal Medicine, St. Louis University Health Sciences Center, MI 63104, USA.
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MeSH Terms
Calcium Channel Blockers / adverse effects*
Hypertension / drug therapy
Myocardial Infarction / chemically induced*
Myocardial Ischemia / drug therapy
Nifedipine / adverse effects,  therapeutic use
Reg. No./Substance:
0/Calcium Channel Blockers; 21829-25-4/Nifedipine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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