Calcium Channel Blockers Revisited

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Calcium Channel Blockers Revisited

Much has been written in the past year about possible adverse effects of short-acting calcium channel antagonists, such as nifedipine, in patients with coronary artery disease (CAD). Some adverse outcomes occur with the use of short-acting drugs in hypertensive patients with imperfect blood pressure control or in cases of acute MI, where these drugs are not indicated.

This Israeli study examined more than 11,000 patients who were screened, but not included, in a lipid reduction trial. Approximately half the patients (5843) were taking a short-acting calcium antagonist (nifedipine, verapamil, or diltiazem) and were compared with 5732 controls. Mortality data were obtained at a mean follow-up of 3.2 years. The groups were well-matched for baseline clinical variables and most had angina or a history of MI. Hypertension was more common in the treated patients (38% vs. 29%).

The mortality rate was 8.5% in patients using calcium antagonists and 7.2% in controls (risk ratio 1.08, not significant). With adjustment for age, gender, previous MI, and other risk factors, the risk ratio declined to 0.97. There were no differences in mortality among patients taking the three calcium channel antagonists.

Comment: This study does not support the theory that short-acting calcium channel antagonists are harmful to patients with CAD or survivors of MI.

Several studies have supported the safety and efficacy of long-acting calcium channel blockers for hypertension in patients with stable CAD. However, both short- and long-acting calcium antagonists should be avoided in the acute ischemic syndromes, where their use is inappropriate.

— HC Herrmann

Published in Journal Watch Cardiology September 1, 1996

Citation(s):

Braun S et al. Calcium antagonists and mortality in patients with coronary artery disease: A cohort study of 11,575 patients. J Am Coll Cardiol 1996 Jul 28 7-11.

Medline abstract (Free)

Messerli FH. Whatever happened to the calcium antagonist controversy? J Am Coll Cardiol 1996 Jul 28 12-13.

Medline abstract (Free)

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