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 .
Effect of calcium channel or beta-blockade on the progression of diabetic nephropathy in African Americans.
beta-Blockers are known to slow the progression of diabetic nephropathy by lowering arterial pressure . Moreover , in individuals with diabetic nephropathy , antihypertensive agents that provide sustained reductions in proteinuria slow the rate of decline in renal function compared with agents without this antiproteinuric effect . To examine whether differential effects on proteinuria affect the progression of diabetic nephropathy , we conducted a r and omized study that compared the effects of a heart rate-lowering calcium channel blocker , sustained-release verapamil , with those of a beta-blocker , atenolol , on the progression of diabetic renal disease . The primary end point of the study was a change in creatinine clearance slope .  Thirty-four African Americans with the following inclusion criteria were r and omized to one of the two groups : serum creatinine greater than 1.4 mg/dL , proteinuria greater than 1500 mg/d , longer than a 5-year history of both non-insulin-dependent diabetes mellitus and hypertension , and exclusion of other renal diseases . Goal blood pressure was less than 140/90 mm Hg . All subjects received loop diuretics as second line agents to help achieve the blood pressure goal . Twenty-four-hour urinary protein and sodium excretions as well as creatinine clearance were measured at 6-month intervals . Blood pressure was measured every 3 months . After a mean follow-up of 54+/-6 months , the calcium channel blocker group demonstrated both a slower rate of decline in creatinine clearance ( -1.7+/-0.9 versus -3.7+/-1.4 mL/min per year per 1.73 m2 , P<.01 ) and a greater reduction in proteinuria compared with the atenolol group . Additionally , a greater proportion of the atenolol group had a 50 % or more increase in serum creatinine compared with the verapamil group ( 32+/-9 % versus 16+/-7 % , P<.05 ) . These between-group differences could not be explained by differences in blood pressure control . These data support the concept that antihypertensive agents that persistently maintain reductions in both arterial pressure and proteinuria slow the progression of diabetic renal disease in African Americans to a greater extent than those agents without these effects
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 .