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 .
Antihypertensive monotherapy with nisoldipine CC is superior to enalapril in black patients with severe hypertension.
A single-center , prospect i ve double-blind r and omized trial was conducted to compare the efficacy and safety of the calcium channel blocker nisoldipine in a sustained release coat-core formulation ( CC ) , titrated from 10 mg to 40 mg daily , with the angiotensin converting enzyme inhibitor enalapril , titrated from 10 to 40 mg daily , in the treatment of black South African patients with severe hypertension ( sitting diastolic blood pressure [ DBP ] between 115 and 140 mm Hg , confirmed by 24-h ambulatory blood pressure monitoring ) . Treatment target was a sitting DBP < 95 mm Hg by the 9th week of treatment . This was followed by a 4-month open phase using nisoldipine CC 10 to 60 mg daily . Ninety-six patients had complete data at baseline , and at the end of the double-blind and open phases , and were included in this analysis . In both groups , all patients required titration up to the maximal dose of double-blind medication . Monotherapy with nisoldipine CC , but not enalapril , significantly reduced both sitting and 24-h ambulatory blood pressure ( BP ) . Twenty-four-hour BP in the nisoldipine CC group decreased from 179+/-14 / 118+/-7 to 144+/-16 / 94+/-10 mm Hg ( P < .0001 ) versus 181+/-13 / 117+/-5 to 171+/-17 / 110+/-11 mm Hg in the enalapril group ( P = ns ) . The profound decrease in blood pressure achieved with nisoldipine CC was accompanied by a significant reduction in left ventricular [ LV ] mass index , observed after only 2 months of treatment ( from 146+/-40 to 129+/-35 g/m2 , P = .05 ) . In contrast , enalapril had no effect on LV mass ( from 139+/-36 to 142+/-50 g/m2 , P = NS ) . The antihypertensive effect of nisoldipine CC was further demonstrated in the open phase , during which 24-h BP decreased from 180+/-14 / 118+/-6 mm Hg ( at baseline ) to 142+/-16 / 92+/-10 mm Hg at the end of the 16-week open phase ( P < .0001 ) . This effect was sustained with trough-to-peak ratio of 74 % for systolic and 67 % for diastolic BP , with further regression in LV mass . Reduction in 24-h systolic BP to < 135 mm Hg was associated with a greater degree of regression of LV mass index in patients treated with nisoldipine CC . The incidence of adverse events in both groups was low and both nisoldipine CC and enalapril were well tolerated . The incidence of significant ventricular arrhythmia was also low and did not change with treatment . In conclusion , our findings suggest that nisoldipine CC administered once daily could be considered as a suitable first-line antihypertensive agent in black patients with severe hypertension , based on its profound and sustained blood-pressure-lowering effect , associated with significant regression of left ventricular mass and its low side effect profile
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 .