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 .
The Verapamil in Hypertension and Atherosclerosis Study (VHAS): Results of long‐term randomized treatment with either verapamil or chlorthalidone on carotid intima‐media thickness
Background It is unclear whether the carotid intima – media thickness can be influenced by antihypertensive treatment and whether some antihypertensive agents , such as calcium antagonists , may have a greater effect on this parameter than others , such as diuretics . The present paper reports the principal results of the ultrasound sub study of the r and omized , prospect i ve , controlled , Verapamil in Hypertension and Atherosclerosis Study ( VHAS ) . Design and methods In 498 hypertensive patients in eight Italian centres , r and omized to either verapamil ( 240 mg once a day ) or chlorthalidone ( 25 mg once a day ) , a B-mode ultrasound scan was performed according to a st and ardized procedure at baseline and after 3 , 12 , 24 , 36 and 48 months of treatment . The maximum intima – media thicknesses of the far walls of common , bifurcation and internal carotid arteries were measured bilaterally , and the following indices calculated : the mean thickness at the six measured sites , the mean thickness at the common and bifurcation sites and the single maximum thickness . The primary endpoint for treatment efficacy was the slope of the change over 4 years ( rate of change , mm/year ) , corrected by using the initial mean over the six sites ( baseline + 3 months ) as a covariate ( mm/year per mm ) . The patients were also classified into three strata according to their baseline single maximum thickness : those with normal carotid arteries ( single maximum ( 1 mm ) , those with thickened carotid arteries ( single maximum > 1 and ≤ 1.5 mm and those with carotid plaques ( single maximum > 1.5 mm ) . Results Among the 456 patients with satisfactory baseline ultrasound readings , 33 % were classified with normal carotid arteries , 27 % with thickened carotid arteries and 40 % with plaques . In the intention-to-treat population ( 377 patients with ultrasound measurements taken on at least three different occasions over a period of at least 2 years ) , the rate of change in the mean thickness at the six sites measured was rather small ( 0.015 mm/year ) , but significantly ( P < 0.05 ) smaller in patients with plaques ( 0.003 mm/year ) than in patients with thickened or with normal carotids ( 0.023 and 0.025 mm/year , respectively ) . When related to initial values , the rate of change in the mean thickness at the six sites had a negative slope ( −0.059 mm/year per mm , P < 0.01 ) . Although rates of change in the carotid intima – media thickness in unstratified patients were not different in those treated with verapamil or with chlorthalidone , when changes in the mean thickness of six sites were related to the initial value , the slope of this relationship was significantly different in the two treatment groups ( verapamil −0.082 versus chlorthalidone −0.037 mm/year per mm , P < 0.02 ) . The blood pressure-lowering effect of the two r and omized treatments was similar . Taking fatal and nonfatal , major and minor cardiovascular events together , there were 19 events in the verapamil group and 35 in the chlorthalidone group , with a significantly ( P < 0.01 ) greater incidence in patients with plaques , and among patients with plaques in those who were r and omized to chlorthalidone ( P < 0.05 ) . Conclusions In accord with evidence from animal models of atherosclerosis , the calcium antagonist verapamil was more effective than the diuretic chlorthalidone in promoting regression of thicker carotid lesions . Changes in the carotid intima – media thickness were small in both groups , and the differences between the changes under the two treatments were consequently small , but the observation that these small differences in carotid wall changes were paralleled by differences in the incidence of cardiovascular events ( better intima – media thickness regression with verapamil paralleled by a lower cardiovascular event rate ) suggests that even small effects on carotid plaques may have clinical and prognostic relevance
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 .