Are Calcium Channel Blockers First-Line Drugs for the Treatment of Hypertension and Cardiovascular Disease?

Calcium channel blockers (CCB) represent a class of drugs widely used for treatment of hypertension and coronary heart disease. Some case-control studies published 10 years ago that included patients treated with short acting dihydropyridines reported several apparently harmful actions of this class of drugs, such as increased risk of myocardial infarction, cancer and gastrointestinal bleeding. However, in the last six years a large body of evidence derived from various controlled clinical trials has clearly demonstrated that long-acting CCB are beneficial drugs for treating hypertension and coronary heart disease. Studies such as INSIGHT, NORDIL, ALLHAT, VALUE and ASCOT have shown that CCB are not inferior to other antihypertensive drug classes in preventing cardiovascular disease in hypertensives. In fact, the combination of a CCB and an ACE inhibitor is clearly superior in comparison to classic combination of a diuretic and a beta-blocker. Moreover, CCB have a particularly good profile in preventing stroke and carotid and coronary atherosclerosis progression. Finally, the results of another group of trials, such as INVEST, ACTION and CAMELOT have shown that CCB decrease the risk of new events and procedures and also impairs atherosclerosis progression when used in patients with stable coronary heart disease.