Which patients for secondary prevention with calcium-antagonists?

Experimental studies have shown that calcium antagonists are beneficial in reducing myocardial damage following induced infarction and thus substantiate the concept that these drugs may influence reinfarction rate and death following myocardial infarction in man. Multicenter studies with verapamil and nifedipine are in progress but without conclusive results as yet. Which patients--if any--should receive calcium antagonists for secondary prevention after myocardial infarction remains an open question. The answer will depend on whether calcium antagonists are greater, equal or less effective than beta blockers for this purpose. If calcium antagonists should prove more efficacious than beta blockers, it would seem reasonable to give calcium antagonists preference for secondary prevention in those patients where contraindications to these drugs do not exist. If however, beta blockers prove the better alternative, they should be given preference unless beta blockers are contraindicated. The complex question of the future role of drugs in secondary prevention after myocardial infarction is by far not clarified and socioeconomic consequences as well as quality of life will have to be considered in context with drug influence on survival.