Pharmacotherapy in congestive heart failure: reflections on diabetes, clinical trials, and cardiovascular morbidity and mortality.
Hypertension and diabetes are commonly found conditions, which predispose to premature cardiovascular morbidity and mortality. A strong consensus has emerged in support of aggressive blood pressure reduction in order to forestall the almost inevitable complications that follow from being a hypertensive diabetic. As of yet though it is not clearly determined as to what represents the best class(es) of antihypertensive medications to effect such blood pressure reduction. In this regard, considerable debate has arisen as to the cost/benefit ratio of dihydropyridine calcium channel blockers in the hypertensive diabetic. Although studies such as the Fosinopril vs. Amlodipine Cardiovascular Events Trial and the Appropriate Blood Pressure Control in Diabetes study would seem to argue against the use of dihydropyridine calcium channel blockers in the diabetic hypertensive, other studies such as the subset analyses of the Syst-Eur and the Syst-China and the Hypertension Optimal Treatment study provide almost compelling evidence for the safety of low to moderate doses of a dihydropyridine calcium channel blockers in this population. Safety issues of dihydropyridine calcium channel blockers will remain unresolved until the release of the Antihypertensive and Lipid Lowering Study to Prevent Heart Attack results at which time a resolution to this question should be forthcoming. (c)2000 by CHF, Inc.
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Division of Clinical Pharmacology and Hypertension, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA 23298.