November 13, 1995

Calcium Antagonists Should Continue to Be Used for First-Line Treatment of Hypertension

Author Affiliations

Nephrology Section Veterans Affairs Medical Center 1201 NW 16th St Miami, FL 33125

Arch Intern Med. 1995;155(20):2150-2156. doi:10.1001/archinte.1995.00430200025006

OVER THE past 20 years, calcium antagonists have emerged as one of the most attractive and widely used classes of antihypertensive agents. This is attributable to several features that include their efficacy, metabolic neutrality, relatively few side effects, and possible protective effects on target organs such as the kidney.1-3

Despite these attributes, a number of retrospective analyses have suggested that calcium antagonists may be detrimental and may promote adverse cardiovascular events. The first meta-analysis4 on the effects of 1,4-dihydropyridines on outcome included 21 clinical trials and suggested an adverse trend on mortality (365 of 4731 in the-treated patients vs 330 of 4733 control patients; odds ratio, 1.13; and 95% confidence interval [CI], 0.97 to 1.32) and the development of subsequent myocardial infarction (124 of 3645 treated patients vs 111 of 3680 control patients; odds ratio, 1.14; and 95% CI, 0.68 to 1.92).

Recently, Psaty et al5 presented

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