Calcium antagonists, firstline partners for betablockers in hypertension

Abstract

Monotherapy with the calcium antagonists verapamil, nifedipine, nitrendipine or diltiazem was shown to have a good efficacy/tolerability ratio in the treatment of patients with essential hypertension and overall blood pressure responses were comparable as well as similar to those observed with betablockers and diuretics. The antihypertensive effects of the calcium antagonists were directly related to the patient's age, pretreatment blood pressure but indirectly to pretreatment renin. In intraindividual comparisons, antihypertensive responses with verapamil related directly to those obtained with diuretics but indirectly to those seen with betablocker monotherapy. Accordingly, calcium antagonists can be used as first line drugs particularly in older and low renin patients, to a large extent in place of a diuretic, while a betablocker is used primarily for the younger and high renin patients. This concept does not devalue the diuretics, but it may change the order to their use in treatment plan that is oriented towards cardioprotection.