[What role to assign for calcium channel blockers in the treatment of arterial hypertension in 1997?].
What is the place of calcium channel blockers in the treatment of hypertension (HT)? And, more importantly, what is the place of any molecule recognised as being effective to reduce blood pressure figures in the treatment of HT? Beyond the hypotheses which have dominated the rational approach up until now, suggesting a possible answer to these two questions, medical practice is developing towards evidence-based medicine. This opposes two lines of logic:--that which argues that the benefit of treatment of HT is exclusively related to a reduction of blood pressure figure obtained with the use of the most effective molecule or class which is best tolerated in a given clinical context; that which argues that it is impossible to prescribe widely and indefinitely molecules whose real effect on the clinical prognosis of HT and long-term safety are unknown. This new logic no longer recognizes the reduction of blood pressure figures independently of the means used to achieve this reduction as the exclusive guarantee of the benefit of treatment and proposes that treatments which are widely prescribed must have a more detailed clinical evaluation file than that authorized by current practice. Calcium channel blockers were recently adopted as the main subject of this opposition between two logics, probably because several molecules of this class, evaluated in therapeutic trials conducted outside of the context of HT, demonstrated harmful cardiovascular effects and that case-control studies in the context of HT have indicated the possibility of extracardiac adverse effects. It therefore seems useful to try to redefine their place in the treatment of HT in the light of this recent debate and, more importantly, to extend the discussion to several principles of the pharmacological treatment of HT. Leaving current controversies to one side, this review is designed to present several elements of these opposing logics.
Diévart
F
F
Clinique Villette, Dunkerque.
Everaere
S
S
D002121:Calcium Channel Blockers / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic
D002121:Calcium Channel Blockers
Quelle place pour les antagonistes calciques dans le traitement de l'hypertension artérielle en 1997?