May 27, 1996

A Low-Dose Perspective on the Calcium Antagonist Controversy

Arch Intern Med. 1996;156(10):1115-1116. doi:10.1001/archinte.1996.00040041115017

We read, with great interest, the articles and the editorial in your November 13, 1995, issue of the Archives.1-3 Like so many in your readership, we use a large volume of calcium antagonists in the treatment of our hypertensive patients, particularly those with arrhythmias and angina. We have also listened to Furberg and Psaty3 at various meetings. One issue that all the authors1-3 should have addressed in more detail in their articles relates to the dose-response differences of these agents. The Treatment of Mild Hypertension Study4 is alluded to by Epstein2 in regard to comparisons of different antihypertensive agents. However, as the Treatment of Mild Hypertension Study demonstrated, low doses of various classes of pharmacologic agents, as opposed to higher doses, may have differing physiologic effects. Furberg,5 himself, has stated that dose-response differences represent one issue that directed him to the potential problems associated with