Benefit versus risk of calcium antagonists in hypertensive patients with concomitant risk factors

BLOOD PRESSURE REDUCTION AND CARDIOVASCULAR MORBIDITY AND MORTALITY: Several hypertension trials have shown that antihypertensive treatment can reduce the cardiovascular morbidity and mortality accompanying this condition. They have also shown, however, that the reduction does not entirely normalize the risk of hypertensive patients. STRATEGIES TO IMPROVE THE BENEFIT OF ANTIHYPERTENSIVE TREATMENT: Although some of the risk of the hypertensive patient may prove to be irreversible, pathophysiological and clinical evidence obtained in recent years suggests that some modifications to antihypertensive treatment strategies might increase the benefit. For example, greater use of drugs such as calcium antagonists and angiotensin converting enzyme (ACE) inhibitors as first-line agents might bring greater benefits, because some properties of these drugs which are additive to their blood pressure lowering effects, such as regression of cardiovascular structural changes, nephroprotection and delay of atherogenesis, may provide a degree of protection against target-organ damage. ONGOING CLINICAL TRIALS AND THE INTERNATIONAL NIFEDIPINE (GITS) GASTROINTESTINAL SYSTEM STUDY OF INTERVENTION AS A GOAL IN HYPERTENSIVE TREATMENT (INSIGHT): Several ongoing clinical trials are aimed at comparing the effects of calcium antagonists and ACE inhibitors versus beta-blockers and diuretics on cardiovascular morbidity and mortality. INSIGHT is particularly interesting because the effects of nifedipine GITS and a combined thiazide and potassium-sparing diuretic on cardiovascular morbidity and fatal events are being compared in patients with hypertension plus one or more additional risk factors, such as hypercholesterolemia, smoking, diabetes, left ventricular hypertrophy, etc. INSIGHT is therefore the first trial to address, in a prospective fashion, the prognostic influence of antihypertensive treatment in hypertensives with concomitant risk factors.