[ACTION: The clinical study of the month]

The effect of calcium antagonist on clinical outcome is controversial. A recent study investigated the safety and efficacy of the calcium antagonist nifedipine GITS (gastro-intestinal therapeutic system) in patients with stable, but symptomatic coronary disease. ACTION randomised 7.665 patients to double-blind addition of nifedipine 60 mg once daily or placebo during a mean follow-up of 4.9 years. Most patients were already treated by a beta-blocker, a statine, or aspirine. The addition of nifedipine was well tolerated with a low incidence of side effects. With nifedipine, the development of heart failure was reduced by 29 %. There was also a reduction in the need for coronary angiography and bypass grafting (reduction of 18 and 21%, respectively). The primary efficacy and safety outcomes were not different between nifedipine GITS and placebo. The rate of total mortality and cardiovascular death were not significantly different. The addition of nifedipine GITS to convential treatment of stable angina is safe, has no effect on major cardiovascular event free survival, but reduces the need for coronary angiography and interventions.