Epidemiologic review of the calcium channel blocker drugs - An up-to-date perspective oil the proposed hazards

In the setting of soaring popularity, postmarketing studies of calcium chan nel blockers came to suggest an increase in a variety of major adverse end points. The evidence, however, was largely observational, and large-scale t rials capable of addressing the concerns were wanting. Clinical trials now support the safety and efficacy of the long-acting dihydropyridines for pat ients with both uncomplicated and diabetic hypertension, although conventio nal therapies and, in the latter case, angiotensin-converting enzyme inhibi tors have superior proof of benefit. By contrast, short-acting dihydropyrid ines should be avoided. In the acute coronary syndromes, P-blockers remain the treatment of choice; the evidence for nondihydropyridines remains incon clusive. Stable angina calls for P-blockers as first-line therapy and nondi hydropyridines as second-line therapy, whereas in ventricular dysfunction, safety data for nondihydropyridines are lacking. Initial reports of cancer, bleeding, and suicide have been contradicted by subsequent data, making th e associations uncertain or unlikely. Remaining questions await completion of ongoing trials to better define the indications for these agents.