Infarction risk found with calcium channel blocker

Hypertensive patients with diabetes who are treated with the long acting calcium channel blocker nisoldipine are five times more likely than patients treated with the angiotensin converting enzyme inhibitor enalapril to have a heart attack. These unexpected findings caused one arm of a study to be stopped and have raised renewed concerns over the safety of calcium channel blockers.

The appropriate blood pressure control in diabetes trial was led by Raymond Estacio and Robert Schrier from the University of Colorado Health Science Center (New England Journal of Medicine 1998;338:645-52). The researchers enrolled 470 patients with non-insulin dependent diabetes mellitus who were divided into two cohorts—one with high blood pressure and one with normal blood pressure. These cohorts were randomised to receive either intensive treatment of blood pressure, with the goal of dropping diastolic pressures by 10 mm Hg, or moderate treatment with no change in baseline diastolic blood pressures.

The normotensive cohort was subdivided into three groups—half of the cohort received placebo while the remaining half was equally divided into one …