"SHOULD CALCIUM BLOCKERS BE AVOIDED IN HYPERTENSION?" >Page 1,
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What’s the patient with hypertension to do?
Patients with hypertension should keep some things in mind in view of the controversy over the use of calcium blockers.
First, several studies have suggested for years that calcium blockers are associated with an increase in the risk of heart attacks. Indeed, a few years ago the National Heart, Lung and Blood Institute issued a warning that, based on recent data, the short-acting form of the calcium blocker nifedipine should probably not be used in treating hypertension or angina. (The pharmaceutical industry quickly fell back to the position that long-acting calcium blockers have not been shown to carry such risk.) Thus, the results of Furberg’s meta-analysis do not come out of left field, but tend to confirm suspicions long held.
Second, it is now becoming apparent that not all drugs that lower blood pressure are equivalent. A recent study showed that the drug doxazosin, which lowers blood pressure effectively, does not yield as favorable an outcome as other antihypertensive drugs. Further, evidence is accumulating that ACE inhibitors may give better outcomes in hypertensive patients, especially those with diabetes. So it would not be unheard of for a class of drugs that are quite effective at lowering blood pressure, such as calcium blockers, to yield inferior outcomes from other antihypertensive drugs.
Third, when medical science is left with a meta-analysis to give the answer to a clinical question, the most you can hope for is the best “guess” possible. Thus, serious and well-meaning experts can legitimately differ on whether calcium blockers are dangerous, even after several studies have been conducted and analyzed.
Fourth, most patients with hypertension have an array of effective drugs that can be prescribed for them. Calcium blockers are not a must.
Given all of the above, the most judicious approach is probably the one recommended by Furberg. Since calcium channel blockers, at the very least, might yield a significantly higher incidence of heart attacks and heart failure than other antihypertensive drugs, the best advice would be to avoid calcium blockers altogether. A logical response for physicians would be to treat with other drugs whenever possible, and use the calcium blockers only when other drugs – alone or in combination – do not effectively control the blood pressure. Why take a drug that might cause serious problems if other drugs that do not cause these problems are available?
There are still a few ongoing clinical trials that might, over the next few years, clarify the issue of using calcium blockers in hypertension. But for now, if you are taking calcium blockers for hypertension, you ought to consider talking with your doctor about switching to a diuretic, a beta blocker, an ACE-inhibitor, or a combination of these drugs.
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