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Clinical trial experience around the globe: focus on calcium-channel blockers
1Department of Medicine, Division of Hypertension and Clinical Pharmacology, Clinical Trials Unit, University of Connecticut School of Medicine, Farmington, Connecticut 06030-3940, USA. WWhite@NSO1.UCHC.EDU
Insights
Calcium-channel blockers (CCBs) are vital for managing hypertension and preventing stroke. Recent trials show combination therapy is often needed for optimal blood pressure and outcomes reduction in hypertensive patients.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Management
Background:
- Blood pressure reduction is the primary goal of antihypertensive therapy.
- Calcium-channel blockers (CCBs) are established potent agents for hypertension.
- Long-acting dihydropyridine CCBs show efficacy in stroke prevention.
Purpose of the Study:
- To review recent outcome trials of long-acting CCBs.
- To evaluate CCBs alone or in combination therapy for hypertension.
- To highlight the role of CCBs in managing cardiovascular and cerebrovascular risks.
Main Methods:
- Review of recent large-scale clinical trials and outcome data.
- Analysis of CCB efficacy in monotherapy and combination regimens.
- Focus on long-acting dihydropyridine CCBs and their impact on patient outcomes.
Main Results:
- Multiple drug therapy (average of three agents) is frequently required to achieve blood pressure goals.
- CCBs are effective in reducing stroke risk, as shown in Syst-Eur and Syst-China trials.
- Long-acting CCBs remain crucial in hypertension management, including high-risk populations.
Conclusions:
- The paradigm of hypertension management has shifted towards optimizing combination therapy regimens.
- CCBs are essential components of modern antihypertensive strategies.
- CCBs play a significant role in managing patients at risk for cardiac and cerebrovascular events.
Abstract:
Although certain classes of drugs appear to possess benefits apart from their blood-pressure lowering capability, reduction of blood pressure remains the single most important action of antihypertensive therapy. Calcium-channel blockers (CCBs) have long been recognized as potent agents for hypertension therapy. This is especially true for the prevention of stroke in hypertensive patients as evidenced from the Systolic Hypertension in Europe (Syst-Eur) and Systolic Hypertension in China (Syst-China) trials with a long acting dihydropyridine CCB. The same can be said for beta blockers in patients post myocardial infarction. However, most recent clinical trials have underscored the necessity of multiple drug therapy to achieve the goals of blood pressure reduction coupled with outcomes reduction. For example, the many recent large-scale clinical trials have required an average of three or more agents to achieve goal. Thus, the paradigm for hypertension management has been altered to determine the best treatment regimen rather than the best initial agent. While response rates to individual agents across a wide spectrum of patients vary little, not all drugs are equally suited as companion products. In this article, we discuss the most recent outcome trials with the long acting CCBs alone or in combination with other drugs. The evidence shows that calcium antagonists remain an important part of hypertension management, including in those individuals at risk of cardiac and cerebrovascular events.