Calcium antagonists and beta-blockers: impact on cardiovascular and cerebrovascular events.
It is well established that elevated blood pressure is a major risk factor for cardiovascular and cerebrovascular events, and that controlling hypertension reduces these risks. Although most classes of antihypertensive agents play a role in risk reduction, none offers blanket reductions for all adverse events. The beta-blockers, while the agents of choice for those with ischemic heart disease and for disease states requiring reducing heart rate, are inappropriate first-line therapies in patients whose primary concern is stroke risk reduction. In patients who require heart rate-lowering therapy but who cannot tolerate beta-blockers, long-acting nondihydropyridine calcium antagonists offer the benefits of heart rate reduction, as well as the vasodilation that is characteristic of the calcium antagonists as a class. This article reviews the data on risk reduction involving the beta-blockers and calcium antagonists, as well as other antihypertensive classes that have been shown to reduce the risk of cerebrovascular and cardiovascular disease.
Messerli
Franz H
FH
St. Luke's-Roosevelt Hospital Center, New York, New York 10019, USA. fmesserli@chpnet.org
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D012306:Risk; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers