Document Detail

Calcium channel blockers in hypertension: reappraisal after new trials and major meta-analyses.
MedLine Citation:
PMID:  11710789     Owner:  NLM     Status:  MEDLINE    
This review evaluates the current position of calcium channel blockers (CCB) in antihypertensive treatment in the light of three major comparative studies and two extensive meta-analyses. The latter both show that CCB are equivalent to conventional (initial beta-blocker or diuretic therapy) when total and cardiovascular mortality are the end points. Divergent points between the meta-analyses include stroke and myocardial infarction (MI). One meta-analysis compared CCB with conventional therapy, to find a small 13% reduction in stroke and a small, nonsignificant 12% increase in MI. The other meta-analysis found a 26% increase in MI when CCB were compared with all other therapies including the angiotensin converting enzyme (ACE) inhibitors. This increase was most robust (P < .001) when comparing CCB with ACE inhibitors, consonant with proposed protective effects of ACE inhibitors on cardiovascular risk. At present, only the comparison of CCB with conventional therapy, and not that with ACE inhibitors, rests on secure comparative data. When cost is compelling, conventional therapy is less expensive. For the individual patient, issues of quality of life (for example, impotence with diuretics and beta-blockers) might be decisive. Nonetheless, beta-blockers are preferred in postinfarct patients or in those with heart failure or unstable angina (a contraindication to dihydropyridines in the absence of beta-blockade). In others, the benefits of only a borderline stroke reduction with CCB versus an equally borderline increase in MI should be evaluated for each individual patient, taking into account the age group and the patient's preferences. In conclusion, overall CCB are neither better nor worse than conventional therapy, allowing for possible small differences in stroke and MI. The ACE inhibitors may protect better, although data are incomplete.
L H Opie
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  American journal of hypertension     Volume:  14     ISSN:  0895-7061     ISO Abbreviation:  Am. J. Hypertens.     Publication Date:  2001 Oct 
Date Detail:
Created Date:  2001-11-16     Completed Date:  2002-02-15     Revised Date:  2009-02-24    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1074-81     Citation Subset:  IM    
Cape Heart Centre, University of Cape Town, South Africa.
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MeSH Terms
Adrenergic beta-Antagonists / adverse effects,  therapeutic use
Angiotensin-Converting Enzyme Inhibitors / adverse effects,  therapeutic use
Calcium Channel Blockers / adverse effects,  therapeutic use*
Clinical Trials as Topic*
Diuretics / adverse effects,  therapeutic use
Hypertension / drug therapy*,  mortality
Meta-Analysis as Topic*
Myocardial Infarction / chemically induced
Stroke / prevention & control
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Calcium Channel Blockers; 0/Diuretics
Erratum In:
Am J Hypertens 2001 Dec;14(12):1280

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

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