Has the role of calcium channel blockers in treating hypertension finally been defined?

Abstract

Several large, prospective, randomized, clinical outcome trials have shown that calcium channel blockers are effective and safe antihypertensive drugs compared with placebo and reduce the cardiovascular morbidity and mortality of treated patients. In other studies, when compared with conventional antihypertensive drugs, they demonstrated similar blood pressure-lowering effects and similar reductions in cardiovascular morbidity and mortality, with the exception of a higher incidence of heart failure and fatal myocardial infarction in some studies. However, considering all the evidence available today, these drugs should be considered safe for the treatment of the uncomplicated hypertensive patient in combination with other drugs. They can also be used as first-line therapy for older, stroke-prone hypertensive patients. In addition, when a calcium channel blocker is indicated for better blood pressure control, its use should not be withheld for safety concerns.

Possible pathophysiologic mechanisms supporting the superior stroke protection of angiotensin receptor blockers compared to angiotensin-converting enzyme inhibitors: clinical and experimental evidence

“…15 Similar results have been reported by other clinical trials using diuretics 16,17 or calcium channel blockers. 18,19 Contrary to the above presented results are the findings from randomized clinical trials using ACEIs. In the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), the initial treatment of poststroke hypertensive patients with the ACEI perindopril, resulted in a meager 5% stroke reduction for a 5 mmHg decrease in SBP, compared to 43% stroke reduction, when the diuretic indapamide was added to the ACEI, for an additional SBP decrease of 7 mmHg.…”