Calcium channel blockers in the treatment of hypertension and prevention of cardiovascular disease: results from major clinical trials

Abstract

The ability of antihypertensive agents such as ss-blockers and thiazide and thiazide-like diuretics to reduce the risk of cardiovascular disease is well documented. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was undertaken to determine whether the newer classes of antihypertensive drugs-namely, calcium channel blockers (CCBs), alpha-1 blockers, and angiotensinconverting enzyme (ACE) inhibitors-were as effective as the older agents in preventing cardiovascular events. The results of ALLHAT showed that the diuretic chlorthalidone, the CCB amlodipine, and the ACE inhibitor lisinopril were equally effective in preventing the primary outcome-fatal coronary heart disease or nonfatal myocardial infarction. However, chlorthalidone and lisinopril were more effective at preventing heart failure, whereas amlodipine and chlorthalidone were more effective than lisinopril at preventing stroke. The ALLHAT findings, as well as those of other large, randomized, controlled antihypertensive trials, confirm the value of lowering blood pressure as an approach to reducing the risk, incidence, and economic burden of cardiovascular disease.