Education And Debate

Fortnightly Review: Short acting dihydropyridine (vasodilating) calcium channel blockers for hypertension: is there a risk?

BMJ 1996; 312 doi: http://dx.doi.org/10.1136/bmj.312.7039.1143 (Published 04 May 1996) Cite this as: BMJ 1996;312:1143
  1. D G Beevers, president, British Hypertension Societya,
  2. P Sleight, past president, British Hypertension Societyb
  1. a City Hospital, Birmingham B18 7QH
  2. b John Radcliffe Hospital, Oxford OX3 9DU
  1. Correspondence to: Professor Sleight.

    Abstract

    Summary points

    • Only thiazide diuretics and β blockers have been shown to prevent myocardial infarction and stroke in properly randomised and blinded studies in patients with hypertension

    • The efficacy of calcium channel blockers and angiotensin converting enzyme inhibitors in preventing myocardial infarction and stroke and reducing mortality in hypertensive patients has not been studied

    • The current licensing and clinical use of calcium channel blockers and angiotensin converting enzyme inhibitors in hypertension have been based on surrogate end points such as reduction of blood pressure or left ventricular hypertrophy, or both, or reduction of microproteinuria or macroproteinuria

    • Observational data on short acting dihydropyrridine calcium channel blockers are worrying; there is urgent need for proper large scale randomised trials of calcium channel blockers in hypertension

    • Trials in ischaemic heart disease suggest that in the absence of left ventricular dysfunction verapamil and diltiazem are preferred choices if a calcium, channel blocker is needed in the non-acute setting

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