Safety of calcium antagonists: dissecting the evidence

Based on reports about short-acting calcium antagonists, several recent publications have questioned the safety of agents in this class, particularly of nifedipine. However, these articles contain major limitations and pitfalls; one includes several errors. This does not imply that acute-release nifedipine is safe; in fact, it is well known that short-acting nifedipine can cause a precipitous and potentially dangerous fall in arterial pressure. Calcium antagonists differ from each other in clinically significant ways; therefore, conclusions about one type of calcium antagonist are not automatically applicable to others. Preliminary evidence supports the safety and efficacy of long-acting calcium antagonists.