-NEW YORK (Reuters Health) – Calcium channel blockers CCBs – are safe and effective in the treatment of hypertension, according to a report in the January 16th issue of the Journal of the American College of Cardiology. However, there is some evidence that angiotensin-converting enzymes (ACE) inhibitors may be a better choice for diabetics with hypertension.
To examine the safety and efficacy CCBs in the treatment of hypertension, Dr. Lionel H. Opie, of the University of Cape Town Medical School, South Africa, and Dr. Robert Schall, from Quintiles ClinData, South Africa, conducted a meta-analysis based on six studies comparing CCBs with conventional therapy (diuretics or beta-blockers) or with ACE inhibitors. The trials included a total of 24,322 patients.
The researchers found that the risk of total and cardiovascular mortality and of major cardiovascular events was similar for CCBs and conventional therapy. There was a 25% lower risk of nonfatal stroke (p = 0.001) and an 18% higher risk of total myocardial infarction (p = 0.013), chiefly nonfatal, associated with CCBs. "After performing the Bonferroni correction for multiplicity, these p values become 0.004 and 0.052, respectively."
When the team compared CCBs with ACE inhibitors in 1318 diabetic patients, they found a substantially higher risk of nonfatal myocardial infarction (RR = 2.259) and total myocardial infarction (RR = 2.204) with CCBs (p = 0.001 or 0.004 with Bonferroni correction). Total and cardiovascular mortality rates were similar with CCBs and ACE inhibitors.
"To confirm the hypothesis that ACE inhibitors are superior to CCBs in diabetic patients requires more trial data, especially with renal end points," Dr. Opie and colleagues note.
J Am Coll Cardiol 2002;39:315-322.
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