A prospective evaluation of persistence on antihypertensive treatment with different antihypertensive drugs in clinical practice South African hypertension guideline 2011. Effect of irbesartan monotherapy compared with ACE inhibitors and calcium‐channel blockers on patient compliance in essential hypertension patients: A multicenter, open‐labeled, three‐armed study Combinations of olmesartan and a calcium channel blocker or a diuretic in elderly hypertensive patients: a randomized, controlled trial1 Genome-wide response to antihypertensive medication using home blood pressure measurements: a pilot study nested within the HOMED-BP study. Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT): Practical Implications Tolerability of antihypertensive drugs in a community-based setting. Renoprotective Effect and Cost-Effectiveness of Using Benidipine, a Calcium Channel Blocker, to Lower the Dose of Angiotensin Receptor Blocker in Hypertensive Patients with Albumiuria An angiotensin II receptor blocker–calcium channel blocker combination prevents cardiovascular events in elderly high-risk hypertensive patients with chronic kidney disease better than high-dose angiotensin II receptor blockade alone Rationale, design and patient baseline characteristics of OlmeSartan and calcium antagonists randomized (OSCAR) study: a study comparing the incidence of cardiovascular events between high-dose angiotensin II receptor blocker (ARB) monotherapy and combination therapy of ARB with calcium channel bloc Efficacy of Combination Antihypertensive Therapy with Low-Dose Indapamide: Assessment by Blood Pressure Self-Monitoring at Home Use of calcium channel blockers is associated with better cognitive performance in older hypertensive patients with subjective memory complaints Antiproteinuric effects of combined antihypertensive therapies in patients with overt type 2 diabetic nephropathy. Calcium-channel blockers and cognitive function in elderly people: results from the Canadian Study of Health and Aging. Persistence with antihypertensive medication: Australia-wide experience, 2004-2006. A Comparative Study of the Management of Stage 2 hypertension by Combined therapy with Losartan, Amlodipine and Hydrochlorothiazide Calcium channel blockers and cardiac mortality in the treatment of hypertension: a report from the Department of Health Hypertension Care Computing Project (DHCCP) Preferable effects of olmesartan/calcium channel blocker to olmesartan/diuretic on blood pressure variability in very elderly hypertension: COLM study subanalysis Prevention of cardiovascular events with calcium channel blocker-based combination therapies in patients with hypertension: a randomized controlled trial The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2 - therapy. Calcium-Channel Blockers and Dementia Risk in Older Adults　- National Health Insurance Service - Senior Cohort (2002-2013). Comparative study of high dose mono-therapy of amlodipine or telmisartan, and their low dose combination in mild to moderate hypertension. Angiotensin-converting enzyme inhibitors, calcium channel blockers, and breast cancer.
Persistence on treatment affects the efficacy of antihypertensive treatment . We prospect ively investigated the persistence on therapy and the extent of  blood pressure ( BP ) control  in 347 hypertensive patients ( age 59.4 ± 6 years ) r and omly allocated to a first-line treatment with : angiotensin-converting enzyme ( ACE ) inhibitors , calcium-channel blockers ( CCBs ) , ß-blockers , angiotensin-II receptor blockers ( ARBs ) , or diuretics and followed-up for 24-months . Persistence on treatment was higher in patients treated with ARBs ( 68.5 % ) and ACE inhibitors ( 64.5 % ) vs CCBs ( 51.6 % ; p < 0.05 ) , β-blockers ( 44.8 % , p < 0.05 ) , and diuretics ( 34.4 % , p < 0.01 ) . No ARB , ACE inhibitor , β-blocker , or diuretic was associated with a higher persistence in therapy compared with the other molecules used in each therapeutic class . The rate of persistence was significantly higher in patients treated with lercanidipine vs others CCBs ( 59.3 % vs 46.6 % , p < 0.05 ) . Systolic and diastolic BP was decreased more successfully in patients treated with ARBs ( −11.2/−5.8 mmHg ) , ACE inhibitors ( −10.5/−5.1 mmHg ) , and CCBs ( −8.5/−4.6 mmHg ) compared with ß-blockers ( −4.0/−2.3 mmHg p < 0.05 ) and diuretics ( −2.3/−2.1 mmHg , p < 0.05 ) . No ARB , ACE inhibitor , β-blocker , or diuretic was associated with a higher BP control compared with the other molecules used in each therapeutic class . A trend toward a better BP control was observed in response to lercanidipine vs other CCBs ( p = 0.059 ) . The present results confirm the importance of persistence on treatment for the management of hypertension in clinical practice OUTCOMES Extensive data from r and omised controlled trials have shown the benefit of treating hypertension . The target blood pressure ( BP ) for antihypertensive management is systolic < 140 mmHg and diastolic < 90 mmHg with minimal or no drug side-effects ; however , stricter BP control is required for patients with end-organ damage , co-existing risk factors and co-morbidity , e.g. diabetes mellitus . The reduction of BP in the elderly and in those with severe hypertension should be achieved gradually over 1 month . Co-existent risk factors should also be controlled . BENEFITS Benefits of management include reduced risks of stroke , cardiac failure , chronic kidney disease and coronary heart disease . RECOMMENDATIONS The correct BP measurement procedure is described , and evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy are stipulated . The total cardiovascular disease risk profile should be determined for all patients to inform management strategies . Lifestyle modification and patient education are cornerstones in the management of every patient . Major indications , pre caution s and contra-indications to each recommended antihypertensive drug are listed . Combination therapy should be considered ab initio if the BP is ≥ 20/10 mmHg . First-line drug therapy for uncomplicated hypertension includes low-dose thiazide-like diuretics , calcium channel blockers ( CCBs ) or angiotensin-converting enzyme inhibitors ( ACE-Is ) ( or ARBs - angiotensin II receptor blockers ) . If the target BP is not obtained , a second antihypertensive should be added from the aforementioned list . If the target BP is still not met , the third remaining antihypertensive agent should be used . In black patients  either thiazide-like diuretics or CCBs can be used initially , because response rates are better than with ACE-Is or β-blockers . In treating resistant hypertension , a central ly acting drug , vasodilator , α-blocker , spironolactone or β-locker should be added . This guideline includes management of specific situations , i.e. hypertensive emergency and urgency , severe hypertension with target organ damage , hypertension in diabetes mellitus , resistant hypertension , fixed drug combinations , new trials in hypertension , and interactions of antihypertensive agents with other drugs . VALIDITY The guideline was developed by the Southern African Hypertension Society Objectives . This multicenter , three‐armed , open‐labeled study investigated patient compliance of patients receiving irbesartan , angiotensin‐converting enzyme ( ACE ) inhibitors or calcium‐channel blockers ( CCB ) for essential hypertension for a 6‐month period . Patients were either newly diagnosed or switched from existing antihypertensive medication due to lack of efficacy or side‐effects . Methods . Patients were started monotherapy with irbesartan ( n = 377 ) , ACE inhibitors ( n = 298 ) or CCB ( n = 308 ) and were reevaluated on 1st , 3rd , and 6th months of the treatment . The primary endpoint was patient compliance , assessed by proportion of patients who had taken their study medication every day . Efficacy was recorded as mean reductions in blood pressure and the proportion of patients whose blood pressure normalized . Tolerability was assessed by reported adverse events . Results . Significantly more patients receiving irbesartan had complied with study medication after 3 and 6 months of treatment than ACE inhibitors or CCB . Significantly fewer patients receiving irbesartan needed to change their antihypertensive medication . All three study treatments exhibited similar efficacy profiles , but irbesartan had significantly less adverse events . Conclusions . This study demonstrated that patient compliance to irbesartan was significantly superior to other study treatments . Irbesartan is therefore a suitable first‐line therapy for essential hypertension in everyday clinical practice Objective : The aim of the present study was to compare the cardiovascular effects of olmesartan , an angiotensin II receptor blocker , combined with a calcium channel blocker ( CCB ) or a diuretic , in a prospect i ve , r and omized , open-label , blinded endpoint trial . Methods : Japanese hypertensive patients aged at least 65 to less than 85 years with SBP at least 140 mmHg and /or DBP at least 90 mmHg with antihypertensive treatment , or SBP at least 160 mmHg and /or DBP at least 100 mmHg without antihypertensive treatment were r and omized to receive olmesartan with either a dihydropyridine CCB or a low-dose diuretic . If SBP and /or DBP remained at least 140 and /or at least 90 mmHg , the other antihypertensive drug was added . The primary endpoint was a composite of fatal and nonfatal cardiovascular events . The median follow-up time was 3.3 years . Results : Blood pressure decreased similarly in both groups . The primary endpoint occurred in 116/2568 patients ( 4.5 % ) in the olmesartan plus CCB group and in 135/2573 patients ( 5.3 % ) in the olmesartan plus diuretic group [ hazard ratio 0.83 , 95 % confidence interval ( CI ) 0.65–1.07 , P = 0.16 ] . Rates of all-cause death and cardiovascular deaths were similar . Among patients aged at least 75 years , the incidence of stroke tended to be lower in the olmesartan plus CCB group than in the olmesartan plus diuretic group ( hazard ratio 0.63 , 95 % CI 0.38–1.02 , P = 0.059 , interaction P = 0.019 ) . Fewer patients in the olmesartan plus CCB group ( 8.2 % , 211/2568 ) than in the olmesartan plus diuretic group ( 9.8 % , 253/2573 ; P = 0.046 ) experienced serious adverse events . Conclusion : Despite no significant difference in cardiovascular events , the different safety profiles suggest that the combination of olmesartan and CCB may be preferable to that of olmesartan and diuretic BACKGROUND Patients with mild-to-moderate essential hypertension in the HOMED-BP trial were r and omly allocated to first-line treatment with a calcium channel blocker ( CCB ) , angiotensin-converting enzyme inhibitor ( ACEI ) or angiotensin II receptor blocker ( ARB ) . METHODS We recruited 265 ( 93 for CCB , 71 for ACEI and 101 for ARB ) patients who completed the genomic study .  Home blood pressure was measured for 5 days off-treatment before r and omization and for 5 days after 2 - 4 weeks of r and omized drug treatment . Genotyping was performed by 500 K DNA microarray chips . The blood pressure responses to the three drugs were analyzed separately as a quantitative trait . For replication of SNPs with p < 10(-4 ) , we used the multicenter GEANE study , in which patients were r and omized to valsartan or amlodipine . RESULTS SNPs in PICALM , TANC2 , NUMA1 and APCDD1 were found to be associated with CCB responses and those in ABCC9 and YIPF1 were found to be associated with ARB response with replication . CONCLUSION Our approach , the first based on high-fidelity phenotyping by home blood pressure measurement , might be a step in moving towards the personalized treatment of hypertension The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ( ALLHAT ) , sponsored by the National Heart , Lung , and Blood Institute ( NHLBI ) , is the largest outcome trial of antihypertensive treatment ever carried out and the only large blood pressure ( BP ) trial to be carried out in a US population in the past decade.1 The rationale for ALLHAT , which was design ed in the early 1990s , was the urgent need to determine which of the several classes of antihypertensive drugs that had been developed and released for clinical use was most effective in preventing coronary heart disease ( CHD ) , defined as fatal CHD and nonfatal myocardial infa rct ion.2 The only r and omized trials that had previously compared representatives of the antihypertensive drug classes , the Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents3 and the Treatment of Mild Hypertension Study (TOMHS),4 showed BP reductions with all classes but were not powered to evaluate CHD outcomes . Further , prior outcome trials had shown that the reduction in CHD event rates with antihypertensive treatment was less than expected based on epidemiologic data .5 Adverse effects of study drugs , particularly diuretics , including hypokalemia , hypomagnesemia , hyperuricemia , hyperlipidemia , insulin resistance , and ventricular ectopic activity , had been adduced to account for the disappointing outcomes of earlier trials by off setting the beneficial effects of BP reduction.6,7 To further complicate the picture , benefits beyond BP reduction had been attributed to some antihypertensive drug classes , ie , improved survival and reduced morbidity in persons with heart failure or left ventricular dysfunction treated with angiotensin-converting enzyme ( ACE ) inhibitors8–10 and improved insulin sensitivity and lipid profiles with α-blocker treatment.11 In contrast , another antihypertensive drug class , the dihydropyridine calcium channel blockers ( CCBs ) , had been associated with unfavorable outcomes in patients with acute myocardial infa rct ion or unstable angina.12 There were no data BACKGROUND Outside the experimental environment of clinical trials , the tolerability of angiotensin-converting enzyme inhibitors ( ACEIs ) , calcium channel blockers ( CCBs ) , and the angiotensin II antagonist losartan has not been compared . OBJECTIVES The purpose of this study was to estimate , in current clinical practice , the 3-month cumulative incidence of side effects among first-time users of losartan , ACEIs , and CCBs for hypertension . METHODS We conducted a prospect i ve cohort study through a network of 173 pharmacies across Canada to identify patients with hypertension who were newly prescribed monotherapy with losartan , an ACEI , or a CCB .  Individuals were interviewed by telephone 3 times over a 3-month period to determine perceived side effects of the antihypertensive medication prescribed . Data were analyzed using a multivariate logistic regression model . RESULTS Among the 663 eligible individuals , the 3-month cumulative incidence of perceived side effects was 52.5 % ( 42/80 ) , 60.2 % ( 222/369 ) , and 69.6 % ( 149/214 ) for those treated with losartan , an ACEI , and a CCB , respectively . After adjustment for sex , age , level of education , number of symptoms perceived the week before entering the study , prior use of antihypertensive drugs , current use of any other drug , drug insurance coverage , and duration of hypertension , the odds of reporting a side effect were significantly higher among patients treated with an ACEI ( odds ratio [ OR ] = 1.78 : 95 % CI , 1.02 - 3.12 ) or a CCB ( OR = 2.65 ; 95 % CI , 1.47 - 4.78 ) compared with patients treated with losartan . CONCLUSIONS In a community-based setting , we observed that losartan is better tolerated than ACEIs and CCBs . Given that the occurrence of side effects may contribute to lower adherence to drug treatment , the low incidence of side effects associated with losartan makes it an attractive antihypertensive drug choice In hypertensive patients with chronic renal disease ,  angiotensin receptor blockers ( ARBs ) are among the first-line drugs , and calcium channel blockers ( CCBs ) are recommended as a second line . We examined the effects of two therapeutic strategies using ARBs and benidipine , a CCB , on blood pressure ( BP ) , urinary albumin excretion ( UAE ) , and cost-effectiveness in hypertensive patients with albuminuria . Patients whose BP was 140/90 mmHg or higher despite treatment with low- or medium-dose ARBs were assigned r and omly to two groups . In Group A ( n=14 ) , the ARB dose was maximized and then benidipine was added until BP targets were reached ( < 130/85 mmHg ) . In Group B ( n=18 ) , benidipine was administered first and then the ARB dose was increased until BP targets were reached . The BP targets were achieved by ARB alone in 36 % of Group A patients and by the addition of benidipine in 83 % of Group B patients . Finally , BP decreased in each group , reaching the targets in 93 % of Group A patients and 94 % of Group B patients after a 4-month therapeutic period . UAE was decreased in both groups after a 4-month therapeutic period compared to the allocation period ( −33±6 % in Group A , −31±6 % in Group B ; p<0.001 , respectively ) . The monthly drug cost was higher ( 11,426±880 vs. 8,955±410 yen , p=0.012 ) and the cost-effectiveness of antihypertensive treatment was lower ( p=0.003 ) in Group A than in Group B. We conclude that the addition of benidipine to low- or medium-dose ARB is , in light of the renal protection and the cost-effectiveness of this approach , a useful therapeutic strategy for controlling BP in hypertensive patients with albuminuria The OSCAR study was a multicenter , prospect i ve r and omized open-label blinded end-point study of 1164 Japanese elderly hypertensive patients comparing the efficacy of angiotensin II receptor blocker ( ARB ) uptitration to an ARB plus calcium channel blocker ( CCB ) combination . In this prospect i ve study , we performed prespecified subgroup analysis according to baseline estimated glomerular filtration rate ( eGFR ) with chronic kidney disease ( CKD ) defined as an eGFR < 60 ml/min per 1.73 m2 .  Blood pressure was lower in the combined therapy than in the high-dose ARB cohort in both groups with and without CKD . In patients with CKD , significantly more primary events ( a composite of cardiovascular events and noncardiovascular death ) occurred in the high-dose ARB group than in the combination group ( 30 vs. 16 , respectively , hazard ratio 2.25 ) . Significantly more cerebrovascular and more heart failure events occurred in the high-dose ARB group than in the combination group . In patients without CKD , however , the incidence of primary events was similar between the two treatments . The treatment-by-subgroup interaction was significant . Allocation to the high-dose ARB was a significant independent prognostic factor for primary events in patients with CKD . Thus , the ARB plus CCB combination conferred greater benefit in prevention of cardiovascular events in patients with CKD compared with high-dose ARB alone . Our findings provide new insight into the antihypertensive strategy for elderly hypertensive patients with CKD Higher doses of angiotensin II receptor blockers ( ARBs ) are expected to exert more protective effects against cardiovascular diseases . However , the significance of treatment of hypertension with high-dose ARB remains to be defined . The OlmeSartan and Calcium Antagonists R and omized ( OSCAR ) Study was design ed to determine whether high-dose ARB monotherapy is superior to the combination therapy of ARB plus calcium channel blocker ( CCB ) in the prevention of cardiovascular morbidity/mortality in Japanese elderly high-risk hypertensive patients . The OSCAR study is a multicenter , active-controlled , two-arm parallel group comparison , using the prospect i ve r and omized open-blinded end-point method . In the ‘ Step 1 ’ period , elderly hypertensive patients with diabetes or cardiovascular disease received monotherapy with ARB olmesartan medoxomil at a dose of 20 mg day−1 . If the target blood pressure control ( less than 140/90 mm Hg ) was not achieved by ARB monotherapy , the patients were r and omized to receive either ( 1 ) the increased dose of olmesartan at 40 mg day−1 ( high-dose ARB monotherapy ) or ( 2 ) the addition of a CCB ( amlodipine or azelnidipine ) to 20 mg day−1 olmesartan ( ARB plus CCB combination ) in the ‘ Step 2 ’ period . The follow-up duration will be 3 years . The primary end points will be the composite of fatal and non-fatal cardiovascular events , and death from any cause .  Recruitment for the OSCAR study ( around 1200 patients ) was completed by the end of May 2007 . The OSCAR study is the first large clinical trial comparing the efficacy of high-dose ARB monotherapy with that of an ARB plus CCB combination therapy in elderly high-risk hypertensive patients We examined the effects of the addition of low-dose indapamide to antihypertensive drugs of other classes , as well as its duration of action , using blood pressure ( BP ) self-monitoring at home . Seventy-six patients undergoing monotherapy with a calcium channel blocker ( CCB ) , angiotensin converting-enzyme inhibitor ( ACEI ) , or angiotensin AT1-receptor blocker ( ARB ) , but had an average morning home systolic BP ( SBP ) ≥ 135 mmHg or diastolic BP ( DBP ) ≥ 85 mmHg , were studied .  Indapamide ( 1 mg ) was added to their existing treatment once daily for 4 weeks . The additional hypotensive effects  of indapamide were evaluated by casual and home BPs , and the results were compared among the three groups of subjects classified according to their initial drug treatment classes . The morning/evening ( M/E ) ratio of BP reduction was calculated to assess the duration of the effect . Overall , indapamide significantly ( P < 0.001 ) lowered morning home BP ( 147 ± 12/87 ± 9 mmHg to 135 ± 12/81 ± 9 mmHg ) , evening home BP ( 138 ± 15/79 ± 10 mmHg to 126 ± 12/73 ± 9 mmHg ) , and casual BP ( 145 ± 21/86 ± 14 mmHg to 136 ± 17/81 ± 13 mmHg ) . All groupsshowed significant indapamide-induced home SBP/DBP decreases , whereas only the ACEI and ARB groups , but not the CCB group , showed a home pulse pressure ( PP ) reduction . Evening SBP and PP decreases were significantly greater in the ARB group than in the CCB group . The mean M/E ratio with indapamide was 0.95 for SBP and 0.85 for DBP . Low-dose indapamide used in combination can provide additional anti-hypertensive efficacy lasting for 24 h. The added effect of indapamide may be more prominent on ARBs than on CCBs Background Hypertension is strongly associated with cognitive decline and a promising target for dementia prevention . Our aim was to investigate the association between different antihypertensive treatments and cognitive performance in elderly hypertensive patients presenting with subjective memory complaints . Patients and methods Three hundred and seventy-eight elderly hypertensive patients more than 60 years ( mean age 70.4 ± 6.3 years ) treated with at least one antihypertensive agent and presenting with subjective memory complaints but without dementia were prospect ively recruited and underwent a combination of neuropsychological tests , brain magnetic resonance imaging with semiquantification of white matter hyperintensities , carotid echotracking , brachial endothelial function , and ambulatory blood pressure assessment s. Results None of the three composite scores ( memory score , verbal fluency , and visual memory capacity ) was found associated with blood pressure levels . On the other h and , age-adjusted and sex-adjusted analyses showed a significant and positive association between memory score and use of calcium channel blockers ( CCBs ) ( users : + 0.14 ± 0.09 versus nonusers : −0.12 ± 0.06 ; P = 0.016 ) . Multivariate analyses also revealed that CCB use was significantly associated with a better memory score , independently of age , male sex , white matter hyperintensities , and carotid wall cross-sectional area , all of which were associated with worse memory scores . Conclusion In elderly hypertensive treated patients with subjective memory complaints  , CCB use was associated with better memory performance independently of blood pressure level and macrovascular and microvascular alterations , suggesting a specific neuroprotective effect of this pharmacological class . Interventional controlled trials are required to confirm the specific protective effect of CCBs on cognitive decline Combined antihypertensive therapy plays a crucial role in achieving targeted blood pressure reductions and renoprotection . We therefore compared the antihypertensive and antiproteinuric effects of combined therapy with either a calcium channel blocker ( CCB ) plus an angiotensin II receptor blocker ( ARB ) or an angiotensin converting enzyme inhibitor ( ACE-I ) plus an ARB in patients with type 2 diabetes mellitus complicated by overt nephropathy and mild to moderate hypertension . After a 12-week dietary control period , diabetic patients with mildly to moderately impaired renal function were r and omly assigned to either a CCB ( amlodipine 5 mg once daily ) or an ACE-I ( temocapril 2 mg once daily ) for 12 weeks ( monotherapy period ) . Both groups then received add-on therapy with an ARB ( c and esartan 4 mg once daily ) for an additional 12 weeks . During the monotherapy period , blood pressure was decreased equally well in both groups . Daily urinary protein excretion remained unchanged in the CCB-treated group ( control period , 4.0 + /- 1.8 g/day vs. CCB period , 4.1 + /- 1.9 g/day ; ns ; n = 8) , but decreased in the ACE-I-treated group ( control period , 4.3 + /- 1.8 g/day vs. ACE-I period , 3.5 + /- 1.7 g/day ; p < 0.05 ; n = 9 ) . After the combined therapy period , blood pressure was decreased to the same degree in both groups . Although ARB plus CCB significantly reduced urinary protein excretion ( to 3.5 + /- 1.5 g/day ; p < 0.05 vs. control period ; n = 8) , a more profound reduction was achieved with ARB plus ACE-I ( to 2.6 + /- 1.3 g/day ; p < 0.01 vs. control period ; n = 9 ) . Monotherapy with the ACE-I increased the serum potassium concentration , and this elevation was sustained after addition of the ARB . In contrast , the serum potassium concentration was not influenced by monotherapy with the CCB , but was significantly increased after addition of the ARB . A decreased hematocrit was observed in the ARB plus ACE-I group . The present study suggests that combined antihypertensive therapy with either a CCB plus an ARB or an ACE-I plus an ARB exerts an antiproteinuric effect in patients with type 2 diabetic nephropathy with mildly impaired renal function . Although the latter combination had a more profound effect , it was associated with an increased serum potassium concentration and worsening of renal anemia . Thus , the combination of a CCB and an ARB should be the first line antihypertensive therapy in those with overt diabetic nephropathy . The long-term efficacy of these combined antihypertensive therapies will need to be further addressed in a future study BACKGROUND Concern has been raised about the potential for adverse cognitive effects associated with the use of calcium-channel blockers ( CCBs ) in older people . This study was undertaken to examine prospect ively the association between the use of these and other antihypertensive drugs and cognitive function . METHODS The authors examined data from the Canadian Study of Health and Aging ( CSHA ) , a population -based , prospect i ve 5-year investigation of the epidemiology of dementia and other health problems in Canadians 65 years of age and older . The risk of cognitive decline , as indicated by a decline in performance on the Modified Mini-Mental State ( 3MS ) examination over the 5-year period , was assessed in relation to the use of antihypertensive and diuretic drugs by 205 subjects with a history of hypertension and no evidence of dementia at baseline . RESULTS The proportion of subjects whose cognitive performance declined over the study period was significantly higher in the group using CCBs than in the group using other antihypertensive agents ( 75 % v. 59 % ) . The adjusted odds ratio ( OR ) for a significant decline in cognitive performance ( defined as a decrease in 3MS score of 10 points or more ) was 2.28 ( 95 % confidence interval [ CI ] 1.12 - 4.66 ) for subjects using CCBs . The adjusted ORs ( and 95 % CIs ) for cognitive decline in subjects using selected antihypertensive agents or diuretics relative to those exposed to beta-blockers were as follows : angiotensin-converting-enzyme inhibitor , OR 1.36 ( 95 % CI 0.41 - 4.55 ) ; diuretic or other antihypertensive drug , OR 1.45 ( 95 % CI 0.51 - 4.14 ) ; dihydropyridine CCB ( nifedipine ) , OR 1.94 ( 95 % CI 0.52 - 7.27 ) and non-dihydropyridine CCB ( diltiazem or verapamil ) , OR 3.72 ( 95 % CI 1.22 - 11.36 ) . INTERPRETATION Older people taking CCBs were significantly more likely than those using other agents to experience cognitive decline . These findings are consistent with the results of previous cross-sectional research and emphasize the need for further trials to examine the associations between CCB use , blood pressure and cognitive impairment in elderly patients OBJECTIVE To study persistence and adherence with the use of common  antihypertensive ( AHT ) medications .  DESIGN , SETTING AND PARTICIPANTS Longitudinal assessment of Pharmaceutical Benefit Scheme cl aim records covering the period January 2004 to December 2006 . We analysed a 10 % r and om sample of all Australian long-term health concession card holders who had been commenced on an angiotensin II receptor antagonist ( A2RA ) , an angiotensin-converting enzyme inhibitor ( ACEI ) and /or a calcium channel blocker ( CCB ) , but for whom no AHT medication had been dispensed in the previous 6 months . MAIN OUTCOME MEASURES Proportion of patients failing to fill a second prescription ; median persistence time with medication ( ie , non-cessation of therapy ) ; persistence with medication over 33 months ; median medication possession ratio ( MPR , defined as the proportion of prescribed medication actually consumed by patients persisting with treatment ) . RESULTS The data base yielded information relating to 48 690 patients prescribed AHT medication .  Nineteen per cent of patients failed to collect a second prescription . The median persistence time was 20 months . The data were little different from the population average with respect to A2RAs or ACEIs , but persistence was 57 % poorer with respect to CCBs ( log-rank P < 0.001 ) ( 28 % of patients prescribed CCBs failed to collect a second prescription ; median persistence time , 7 months ) . There were differences in persistence between individual drugs in the respective classes , the best outcomes being with c and esartan and  telmisartan  ( A2RAs ; 10%-20 % better ) , perindopril ( ACEI ; 25 % better ) and lercanidipine ( CCB ; 25 % better ) . Median MPRs were generally around 100 % , indicating that most patients who collected prescriptions also showed good adherence to treatment regimens . CONCLUSION There is an ongoing problem of poor persistence with commonly used AHT medications . This may represent a diminished opportunity for cardiovascular disease prevention Background The most effective and accurate treatment of hypertensive patients  reduces cardiovascular events and improves the quality of life . Objective This study compared the efficacy and safety of combined ( combination therapy ) with an angiotensin-receptor blocker ( ARB ) a calcium-channel blocker ( CCB ) ( Losartan / Amloidipine 50/10 mg ) vs maximal combination doses of ARB with hydrochlorothiazide ( Losartan /HCTZ 100/25 mg ) and maximal combination doses of CCB with HCTZ ( Amlodipine /HCTZ 10/25 mg ) in the management of stage 2 hypertension . Methods This r and omized clinical trial ( RTC ) comprised 478 hypertensive patients with mean age 50.5±5.21 years , and took place between January 2010 and December 2011 in Vasei Hospital clinic in Sabzevar . Antihypertensive drugs were washed out after 5 days of discontinuation of drugs and the patients with mean blood pressure in sitting position ≥ 160 and < 200 mmHg in systole and ≥ 100 and < 110 mmHg in diastole were r and omized into three groups : Losartan / Amlodipine 50/10 mg ( n = 164 ) , Losartan / HCTZ 100/25 mg ( n = 155 ) and Amlodipine / HCTZ 10/25 mg ( n = 159 ) . The end point was reaching the blood pressure below 140/90 within 56 days of treatment in each group . Results There was a significant difference in systolic blood pressure reductions between treatment groups ( P<0.001 ) and also there was a significant difference between groups in reducing diastolic blood pressure ( P<0.01 ) . The highest systolic and diastolic blood pressure reduction respectively was found in Amlodipine/losartane and losartane/HTCZ group . The ANCOVA analysis revealed that only treatment regimen had a significant effect ( P=0.01 ) and other factor including Age , Gender , Diabetes Mellitus , Smoking and High serum cholesterol did n’t have significant effect on blood pressure reduction . Conclusion ARB/CCB combination therapy reduced blood pressure more effectively than the maximal doses of ARB or CCB with HCTZ in stage 2 hypertensive patients within this period of study Objective : A case control study has reported a 60 % higher risk of myocardial infa rct ion in hypertensives treated with a calcium channel blocker ( CCB ) . We examined the Department of Health Hypertension Care Computing Project ( DHCCP ) data to see if we could confirm or refute this suggestion . Design : Two case control studies , matched and unmatched , plus two longitudinal studies from 1 year of presentation , one for all subjects given a CCB  for more than 1 year compared with those not given this drug , and the second comparing survival on the different drugs initially given between 3 and 12 months of follow-up . Subjects : A total of 9328 subjects were included in the analyses and 2154 died . Of these , 6406 received one or more of the following index drugs : 26 % a calcium channel blocker ( CCB ) ; 84 % a diuretic ; 29 % alpha methyldopa ; 12 % a beta-blocker ( BB ) ; and 11 % an angiotensin-converting enzyme ( ACE ) inhibitor . The CCBs were nifedipine , diltiazem or verapamil . Results : In the case control studies a group given diuretics ± other treatments ( but not including one of the index drugs ) provided a reference group with a relative risk ( RR ) of 1.0 . In the matched case control study the adjusted RR for a CCB  without a diuretic was 1.32 ( 95 % CI 0.64–2.70 ) for IHD mortality and 1.05 ( 95 % CI 0.60–1.84 ) for cardiovascular mortality . Similar results were observed for methyldopa , BBs and ACE inhibitors . The results in the unmatched case control analysis were also similar . The longitudinal study comparing all those treated for over 1 year with a CCB with all other treatments showed a RR for total mortality of 1.03 ( 95 % CI 0.85–1.25 ) . The longitudinal study of total mortality according to treatment initiated at 3–12 months found results of a similar magnitude for CCBs , methyldopa and BBs . Conclusions : The reference diuretic group had less severe cardiovascular disease than other groups . Treatment with a CCB , BB or methyldopa was associated with an excess mortality in comparison with this reference group . The excess was similar in the different drug groups Objective : The aims of this sub analysis of the COLM trial [ NCT00454662 ] were to compare visit-to-visit variability ( VVV ) of blood pressure ( BP ) between age groups and between two treatment combinations , that is , the angiotensin II receptor blocker , olmesartan combined with a calcium channel blocker ( CCB ) , or a diuretic and to investigate the effect of VVV of BP on cardiovascular events in elderly hypertensive patients . Methods : Hypertensive patients ages 65–84 years with a history of and /or risk factors for cardiovascular disease were r and omized to receive treatment with olmesartan along with either a CCB or a diuretic  for at least 3 years . This sub analysis comprised 4876 patients who had their office BP measured at least three occasions ( median nine occasions ) during the follow-up period .  VVV of BP was defined by several metrics including the within-individual st and ard deviation of every visit during the follow-up period . Results : VVV of SBP was larger in the very elderly group ( 75–84 years ) than in the elderly group ( 65–74 years ) . VVV of SBP was smaller in the olmesartan along with CCB group than in the olmesartan along with diuretic group , especially in very elderly patients and also isolated systolic hypertensive patients . The incidence rate of primary endpoint increased along with an increment in the SD of SBP in all of the age and treatment groups . Conclusion : VVV of SBP may mediate the preferable effect of combination of angiotensin II receptor blocker along with CCB on cardiovascular events in the very elderly and also isolated systolic hypertensive patients Objectives Current guidelines recommend the use of multiple medications for hypertension . The present study was aim ed at determining which combination was optimal to prevent cardiovascular events . Methods We conducted a prospect i ve , r and omized , open-label , blinded-endpoint trial . Hypertensive out patients aged between 40 and 85 years who did not achieve target blood pressure ( BP<140/90 mmHg ) with calcium channel blocker ( CCB ) benidipine 4 mg/day were r and omly assigned to receive angiotensin receptor blocker ( ARB ) , & bgr;-blocker , or thiazide diuretic in addition to benidipine . Results Among a total of 3501 patients ( 1167 , benidipine-ARB ; 1166 , benidipine-&bgr;-blocker ; and 1168 , benidipine-thiazide ) , 3293 patients ( 1110 , 1089 , and 1094 , respectively ) who received each combination treatment were included in the analysis . Median follow-up was 3.61 years . At the end of the treatment , 64.1 , 66.9 , and 66.0 % of patients in the benidipine-ARB , benidipine-&bgr;-blocker , and benidipine-thiazide groups achieved target BP , respectively . The cardiovascular composite endpoint occurred in 41 ( 3.7 % ) , 48 ( 4.4 % ) , and 32 ( 2.9 % ) patients , respectively : the hazard ratio was 1.26 in the benidipine-ARB ( P = 0.3505 ) and 1.54 in the benidipine-&bgr;-blocker ( P = 0.0567 ) groups compared with the benidipine-thiazide group . The secondary analyses revealed that benidipine and thiazide diuretic significantly reduced the incidence of fatal or nonfatal strokes ( P = 0.0109 ) and benidipine and ARB significantly reduced new-onset diabetes ( P = 0.0240 ) compared with benidipine and & bgr;-blocker . All trial treatments were safe and well tolerated . Conclusion CCB combined with ARB , & bgr;-blocker , or thiazide diuretic was similarly effective for the prevention of cardiovascular events and the achievement of target BP OBJECTIVE To provide up date d , evidence -based recommendations for the prevention and management of hypertension in adults . OPTIONS AND OUTCOMES For lifestyle and pharmacological interventions , evidence was review ed from r and omized controlled trials and systematic review s of trials . Changes in cardiovascular morbidity and mortality were the primary outcomes of interest . However , for lifestyle interventions , blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity and mortality data in this field . For treatment of patients with kidney disease , the progression of kidney dysfunction was also accepted as a clinical ly relevant primary outcome . EVIDENCE A Cochrane collaboration librarian conducted an independent MEDLINE search from 2005 to August 2006 to up date the 2006 Canadian Hypertension Education Program recommendations . In addition , reference lists were scanned and experts were contacted to identify additional published studies . All relevant articles were review ed and appraised independently by both content and method ological experts using prespecified levels of evidence . RECOMMENDATIONS Dietary lifestyle modifications for prevention of hypertension , in addition to a well-balanced diet , include a dietary sodium intake of less than 100 mmol/day . In hypertensive patients , the dietary sodium intake should be limited to 65 mmol/day to 100 mmol/day . Other lifestyle modifications for both normotensive and hypertensive patients include : performing 30 min to 60 min of aerobic exercise four to seven days per week ; maintaining a healthy body weight ( body mass index of 18.5 kg/m2 to 24.9 kg/m2 ) and waist circumference ( less than 102 cm in men and less than 88 cm in women ) ; limiting alcohol consumption to no more than 14 units per week in men or nine units per week in women ; following a diet reduced in saturated fat and cholesterol , and one that emphasizes fruits , vegetables and low-fat dairy products , dietary and soluble fibre , whole grains and protein from plant sources ; and considering stress management in selected individuals with hypertension . For the pharmacological management of hypertension , treatment thresholds and targets should take into account each individual 's global atherosclerotic risk , target organ damage and any comorbid conditions : blood pressure should be lowered to lower than 140/90 mmHg in all patients and lower than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease . Most patients require more than one agent to achieve these blood pressure targets . In adults without compelling indications for other agents , initial therapy should include thiazide diuretics ; other agents appropriate for first-line therapy for diastolic and /or systolic hypertension include angiotensin-converting enzyme ( ACE ) inhibitors ( except in black patients ) , long-acting calcium channel blockers ( CCBs ) , angiotensin receptor blockers ( ARBs ) or beta-blockers ( in those younger than 60 years of age ) . First-line therapy for isolated systolic hypertension includes long-acting dihydropyridine CCBs or ARBs . Certain comorbid conditions provide compelling indications for first-line use of other agents : in patients with angina , recent myocardial infa rct ion , or heart failure , beta-blockers and ACE inhibitors are recommended as first-line therapy ; in patients with cerebrovascular disease , an ACE inhibitor plus diuretic combination is preferred ; in patients with nondiabetic chronic kidney disease , ACE inhibitors are recommended ; and in patients with diabetes mellitus , ACE inhibitors or ARBs ( or , in patients without albuminuria , thiazides or dihydropyridine CCBs ) are appropriate first-line therapies . All hypertensive patients with dyslipidemia should be treated using the thresholds , targets and agents outlined in the Canadian Cardiovascular Society position statement ( recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease ) . Selected high-risk patients with hypertension who do not achieve thresholds for statin therapy according to the position paper should nonetheless receive statin therapy . Once blood pressure is controlled , acetylsalicylic acid therapy should be considered . VALIDATION All recommendations were grade d according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence -Based Recommendations Task Force . All recommendations reported here achieved at least 95 % consensus . These guidelines will continue to be up date d annually BACKGROUND Some disagreements surround the effects of calcium-channel blockers ( CCBs ) on the risk of dementia . The purpose of this study was to investigate the protective effects of CCBs on dementia among elderly hypertensive Koreans . Methods and Results : We conducted a large population -based cohort study using the senior cohort data base of the Korean National Health Insurance Service ( 2002 - 2013 ) . Subjects were elderly hypertensive Koreans older than 60 years of age . A total of 18,423 patients ( CCB user group : 13,692 patients ; non-CCB antihypertensive user group : 4,731 patients ) were statistically analyzed using the Cox proportional hazard regression model to estimate the adjusted hazard ratio ( aHR ) and confidence intervals ( CIs ) of dementia associated with CCB use . There were 2,881 cases ( 21.0 % ) of dementia in the CCB user group and 1,124 cases ( 23.8 % ) in the non-user group . CCB use significantly reduced the risk of total dementia ( aHR 0.81 , 95 % CI 0.75 - 0.87 , P<0.0001 ) , Alzheimer 's dementia ( aHR 0.80 , 95 % CI 0.72 - 0.88 , P<0.0001 ) , and vascular dementia ( aHR 0.81 , 95 % CI 0.70 - 0.94 , P=0.0067 ) . CONCLUSIONS CCB use had a protective effect on the risk of dementia  among elderly hypertensive Koreans . ( Circ J 2016 ; 80 : 2336 - 2342 ) INTRODUCTION Hypertension is one of the major public health challenges worldwide . Angiotensin receptor blockers ( ARBs ) and Calcium channel blockers ( CCBs ) are among the first line antihypertensive drugs . However , optimal treatment strategies in mild to moderate hypertensives who failed to achieve  blood pressure ( BP ) control  with low-dose mono-therapy are not well established . This study was done to compare efficacy and safety of high dose mono-therapy of Amlodipine , Telmisartan and their low dose combination in mild to moderate hypertensives who failed to achieve BP control with low dose mono-therapy of either drug . MATERIAL S AND METHODS A total of 96 patients , fulfilling inclusion and exclusion criteria were enrolled in the study after obtaining informed consent . Patients were r and omized into three treatment groups i.e. Telmisartan 80 mg , Amlodipine 10 mg and low dose combination of Telmisartan 40 mg + Amlodipine 5 mg once daily for two months . The systolic BP , Diastolic BP , and ADRs were recorded at 0 , 2 , 4 , 8 weeks . RESULTS In the present study , significant reduction of mean systolic blood pressure ( SBP ) and mean diastolic blood pressure ( DBP ) was seen in all the three treatment groups . Low dose combination of Amlodipine 5 mg and Telmisartan 40 mg showed statistically significant reduction in SBP as compared to Telmisartan 80 mg mono-therapy and in DBP as compared to Amlodipine 10 mg mono-therapy . Maximum adverse drug reactions ( ADRs ) were reported in Amlodipine mono-therapy group , like ankle oedema , constipation , headache and fatigue . DISCUSSION AND CONCLUSION In term of BP control , low-dose combination therapy appears a better therapeutic approach than high-dose mono-therapy BACKGROUND The use of angiotensin-converting enzyme ( ACE ) inhibitors has been linked to a decreased risk of developing cancer , and longer-term use of calcium channel blockers ( CCBs ) has been associated with an increased risk of developing cancer in general and breast cancer in particular . METHODS Using data from the General Practice Research Data base , we conducted a large case-control analysis . Previous exposure to ACE inhibitors , CCBs , and beta-blockers was compared between 3706 postmenopausal women who were diagnosed with incident breast cancer between 1992 and 1997 and 14155 matched-control women . RESULTS Compared with nonusers of antihypertensive drugs , women who used ACE inhibitors ( odds ratio [ OR ] , 1.0 ; 95 % confidence interval [ CI ] , 0.7 - 1.5 ) , CCBs ( OR , 0.9 ; 95 % CI , 0.7 - 1.2 ) , or beta-blockers ( OR , 1.0 ; 95 % CI , 0.8 - 1.2 ) for 5 or more years were not at an increased or decreased risk of developing breast cancer ( adjusted for smoking and body mass index [ calculated as weight in kilograms divided by the square of height in meters ] ) . The risk of breast cancer did not differ between users of different ACE inhibitors or different CCBs ( dihydropyridines , diltiazem hydrochloride , and verapamil hydrochloride ) or between users of short-acting ( OR , 1.0 ; 95 % CI , 0.7 - 1.4 ) or sustained-release ( OR , 1.0 ; 95 % CI , 0.8 - 1.3 ) nifedipine preparations . CONCLUSION The findings of this large case-control analysis do not support the hypothesis that longer-term use of ACE inhibitors or CCBs affects the risk of developing breast cancer
Diuretics are preferred first-line over CCBs to optimize reduction of cardiovascular events .
The review does not distinguish between CCBs , ACE inhibitors or ARBs , but does provide evidence supporting the use of CCBs over beta-blockers .
BACKGROUND Calcium channel blockers ( CCBs ) are a relatively new antihypertensive class .
The effect of first-line CCBs on the prevention of cardiovascular events , as compared with other antihypertensive drug classes , is unknown .
OBJECTIVES To determine whether CCBs used as first-line therapy for hypertension are different from other first-line drug classes in reducing the incidence of major adverse cardiovascular events .