Treatment of hypertension with calcium channel blockers: European data

In hypertensive emergencies, sublingual nifedipine (10 to 30 mg) is the treatment of choice. Nifedipine, however, may lead to reflex activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system as well as fluid retention when used as a monotherapy for a longer period of time. In chronic arterial hypertension, verapamil, and especially diltiazem seem to be superior to nifedipine. Verapamil (360 to 480 mg a day) and diltiazem (180 to 270 mg a day) produce a consistent antihypertensive effect throughout a 24-hour period. During dynamic or isometric exercise, their antihypertensive potency is equivalent to that of beta blockers. Overall response rate in patients with mild to moderate hypertension is 80 percent with monotherapy. In refractory hypertension, combination with thiazide, reserpine, or clonidine may be useful. Calcium blockers are preferred in older patients with chronic arterial hypertension, and in patients with low renin hypertension, coronary heart disease, peripheral vascular disease, or obstructive airways disease.