BENEFIT VERSUS RISK OF CALCIUM-ANTAGONISTS IN HYPERTENSIVE PATIENTS WITH CONCOMITANT RISK-FACTORS

Blood pressure reduction and cardiovascular morbidity and mortality Se veral hypertension trials have shown that antihypertensive treatment c an reduce the cardiovascular morbidity and mortality accompanying this condition. They have also shown, however, that the reduction does not entirely normalize the risk of hypertensive patients. Strategies to i mprove the benefit of antihypertensive treatment Although some of the risk of the hypertensive patient may prove to be irreversible, pathoph ysiological and clinical evidence obtained in recent years suggests th at some modifications to antihypertensive treatment strategies might i ncrease the benefit. For example, greater use of drugs such as calcium antagonists and angiotensin converting enzyme (ACE) inhibitors as fir st-line agents might bring greater benefits, because some properties o f these drugs which are additive to their blood pressure lowering effe cts, such as regression of cardiovascular structural changes, nephropr otection and delay of atherogenesis, may provide a degree of protectio n against target-organ damage. Ongoing clinical trials and the Interna tional Nifedipine (GITS) gastrointestinal system Study of Intervention as a Goal in Hypertensive Treatment (INSIGHT) Several ongoing clinica l trials are aimed at comparing the effects of calcium antagonists and ACE inhibitors versus beta-blockers and diuretics on cardiovascular m orbidity and mortality. INSIGHT is particularly interesting because th e effects of nifedipine GITS and a combined thiazide and potassium spa ring diuretic on cardiovascular morbidity and fatal events are being c ompared in patients with hypertension plus one or more additional risk factors, such as hypercholesterolemia, smoking, diabetes, left ventri cular hypertrophy, etc. INSIGHT is therefore the first trial to addres s, in a prospective fashion, the prognostic influence of antihypertens ive treatment in hypertensives with concomitant risk factors.