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 .
MIDAS: Hypertension and Atherosclerosis A Trial of the Effects of Antihypertensive Drug Treatment on Atherosclerosis
Although clinical trials of the efficacy of antihypertensive treatment have demonstrated impressive reductions in the incidence of stroke , the reduction in coronary artery disease mortality has been less impressive . It may be that the antihypertensive drugs used in these trials induced metabolic disturbances , or produced inadequate regression of left ventricular hypertrophy , thus blunting the reduction in risk of coronary artery disease expected with blood pressure-lowering . Isradipine , a dihydropyridine calcium antagonist known to be an effective antihypertensive agent , has also displayed pronounced antiatherogenic effects in animals . Thus , a reasonable hypothesis could be that isradipine not only reduces the level of blood pressure , but also may have a positive effect on the evolution of atherosclerotic plaque in coronary and carotid arteries , thereby leading to prevention of clinical sequelae of atherosclerosis . On this basis , a 3-year clinical trial is being carried out in the United States – the Multicenter Isradipine/Diuretic Atherosclerosis Study (MIDAS)–to establish the efficacy of isradipine in inhibiting atherogenesis and retarding the progression of atherosclerosis in carotid arteries of hypertensive patients . The primary end point of the study is intima-media thickness and the extent of atherosclerotic plaque in the carotid arteries , as measured by B-mode ultrasonography
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 .