Morbidity and mortality with dihydropyridines

Calcium antagonists (CaAs) of the dihydropyridine type are widely used in the treatment of hypertension and other cardiovascular disorders. They are markedly effective in lowering elevated arterial pressure, and are well tolerated. Data from long-term intervention trials are emerging, which also show a beneficial effect on cardiovascular morbidity with the use of CaAs in the treatment of hypertension. The first such evidence was from the Shanghai Trial of Nifedipine in the Elderly (STONE), and, in February 1997, the Systolic Hypertension in Europe (Syst-Eur) trial was stopped prematurely because the active treatment, based on a CaA, was found to be significantly better than placebo in preventing cardiovascular disease. In addition, ongoing trials with dihydropyridine CaAs (e.g. the Hypertension Optimal Treatment [HOT] Study and the Swedish Trial in Old Patients with Hypertension-2 [STOP-2]) are close to termination. Final results are not yet available, but cardiovascular morbidity appears to be lower than expected in the HOT Study, suggesting a positive effect of the CaA-based therapeutic regimen. Claims of increased morbidity and mortality from the use of CaAs have been clearly refuted by the thorough scrutiny of all available data by a committee formed by the World Health Organization and the International Society of Hypertension. It can therefore be concluded that the available evidence on the use of dihydropyridine CaAs shows that these agents have a beneficial effect on morbidity. Whether this effect of CaAs is greater than that obtained with conventional therapies, such as diuretics and/or beta-blockers, will be shown by the STOP-2 Study, which is expected to be completed in 1998.