title: Calcium channel blockers: third-line antihypertensives.
abstract: (1) Two new trials have assessed calcium channel blockers in hypertensive patients in terms of cardiovascular morbidity and mortality. (2) In a large unblinded trial, diltiazem had no advantage over diuretic or betablocker therapy in terms of overall cardiovascular prevention or the total incidence of adverse effects. (3) In another trial, sustained-release nifedipine had more adverse effects than a diuretic combination, but the precise difference between the two treatments in terms of preventive effects could not be determined. (4) Some diuretics and betablockers, which have been thoroughly assessed in terms of morbidity and mortality, remain the first choice for antihypertensive drug therapy. Some well-assessed angiotensin-converting-enzyme inhibitors are second-line alternatives. Calcium channel blockers remain a third-line alternative. The risk-benefit ratio of diltiazem, a calcium channel blocker, seems to be closer to that of diuretics and betablockers and better than that of dihydropyridines.
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D005602:France; D006801:Humans; D015201:Meta-Analysis as Topic
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics