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 .
Fosinopril Versus Amlodipine Comparative Treatments Study: A Randomized Trial to Assess Effects on Plasminogen Activator Inhibitor-1
Background —ACE inhibitors and calcium antagonists may modulate fibrinolysis . We conducted a r and omized controlled trial to assess the effects of these drugs on plasminogen activator inhibitor-1 ( PAI-1 ) antigen , an inhibitor of fibrinolysis . Methods and Results — Participants with hypertension and type 2 diabetes mellitus ( n=96 , 51 % black ) were r and omized after an initial 4 weeks of placebo to double-blind 20 or 40 mg fosinopril or 5 or 10 mg amlodipine daily for 4 weeks in a fixed-dose regimen . After 4 weeks of placebo washout , the patients received 4 weeks of crossover treatments . After treatment with placebo  , systolic and diastolic blood pressure were 143±2 and 86±1 mm Hg and plasma PAI-1 was 43.4±2.3 ng/mL. Amlodipine achieved a greater systolic and diastolic blood pressure reduction than fosinopril ( 10 mm Hg versus 8 mm Hg , P = 0.029 , and 5 mm Hg versus 3 mm Hg , P = 0.040 , respectively ) but tended to increase PAI-1 , whereas fosinopril tended to decrease PAI-1 ( 5.4±3.6 versus −3.8±2.5 ng/mL , P = 0.045 ) . The PAI-1 changes depended on drug dose ( 6.5±6.1 and 3.4±3.9 ng/mL with amlodipine 10 and 5 mg , respectively , and −0.4±3.1 and −7.4±4.0 ng/mL with fosinopril 20 and 40 mg , respectively , P for trend 0.024 ) . No significant differences between fosinopril and amlodipine were found for short-term changes in tissue plasminogen activator antigen , fibrinogen , C-reactive protein , and interleukin-6 . The findings were similar in black and white participants . Conclusions —Short-term treatment with fosinopril  significantly reduced PAI-1 compared with amlodipine  in a dose-dependent fashion . This effect , which was independent of blood pressure reduction , may account for the improved clinical outcomes achieved with ACE inhibitors compared with calcium antagonists
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 .