CALCIUM-ANTAGONISTS AND THE DIABETIC PATIENT - A RESPONSE TO RECENT CONTROVERSIES

The results of 2 recently published studies have been interpreted as s uggesting that calcium antagonists are unsafe for the management of hy pertension in patients with diabetes. These 2 studies, the Fosinopril versus Amlodipine Cardiovascular Events Randomized Trial (FACET) and A ppropriate Blood Pressure Control in Diabetes [ABCD), showed that angi otensin-converting enzyme (ACE) inhibitors may be preferable to calciu m antagonists for managing hypertension in diabetic patients; they do not, however, show any harm attributable to calcium antagonists. Indee d, results of the FACET study suggest that the combination of an ACE i nhibitor and a calcium antagonist is effective antihypertensive therap y. This suggestion is supported by findings in the Systolic Hypertensi on in Europe (Syst-Eur) Study, which revealed outstanding benefits of either a calcium antagonist alone or a calcium antagonist combined wit h an ACE inhibitor among diabetic patients with hypertension. The prem ature termination of the hypertensive arm of the ABCD study was puzzli ng because, although 2 of 13 subgroups of 1 of the 5 possible secondar y endpoints in this part of the trial were apparently favorably affect ed by the use of the ACE inhibitor rather than the calcium antagonist, such a finding was compatible with chance alone. If the results of th e FACET and ABCD studies are considered in the context of the best ava ilable data arising from large randomized controlled trials, one may c onclude that calcium antagonists are not harmful or contraindicated in hypertensive patients with diabetes and that the combination of an AC E inhibitor and a calcium antagonist is effective for the management o f hypertension in diabetic patients. (C) 1998 by Excerpta Medica, Inc.