Should calcium antagonists be first line drugs in hypertension?
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Published on: September 22, 2011
1Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC 27157-1063, USA.
Insights
Calcium antagonists are not recommended as first-line hypertension treatment due to safety concerns and lack of long-term data. They should be reserved for patients unresponsive to or intolerant of other proven medications.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension treatment aims to prevent cardiovascular complications, not just lower blood pressure.
- Large-scale, long-term clinical trials on calcium antagonists for hypertension are lacking.
Purpose of the Study:
- To evaluate the efficacy and safety of calcium antagonists in hypertension management.
- To determine the appropriate role of calcium antagonists in hypertension treatment guidelines.
Main Methods:
- Review of existing clinical trials, including smaller studies on dihydropyridines.
- Analysis of reported cardiovascular complications and adverse effects associated with calcium antagonists.
- Consideration of drug cost and comparison with established antihypertensive agents.
Main Results:
- Some trials suggest a paradoxical increase in cardiovascular complications with dihydropyridines, despite blood pressure control.
- Adverse effects are comparable to those seen with short-acting calcium antagonists in coronary patients.
- Concerns exist regarding long-term safety, efficacy, and high cost of calcium antagonists.
Conclusions:
- Calcium antagonists should be considered third-line agents for hypertension.
- Use should be limited to low doses, potentially in combination therapy.
- Reserve for patients intolerant to or uncontrolled by diuretics and beta-blockers.
Abstract:
The goal of the treatment of hypertension is to reduce the risk of the cardiovascular complications--stroke, acute myocardial infarction, congestive heart failure and renal dysfunction--not just to lower an elevated blood pressure. There are no completed large long-term clinical trials of calcium antagonists--short-acting or long-acting--designed to assess their efficacy and safety in patients with hypertension. Two smaller trials of dihydropyridines have suggested that despite blood pressure control, there may be a paradoxical increase in cardiovascular complications. These adverse effects are similar to those reported from clinical trials of short-acting calcium antagonists in coronary patients. Due to concerns about their long-term safety, inadequate documentation of their long-term efficacy and their high cost, calcium antagonists should be reserved as third-line agents. If prescribed, they should be given in low doses, possibly in combination with another antihypertensive agent. Their use should be limited to patients who cannot tolerate the other proven agents such as diuretics and beta-blockers, and to those who are not controlled on these agents or those with relative or absolute contraindication to them.
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