USE OF CALCIUM-ANTAGONISTS IN PATIENTS WITH ISCHEMIC-HEART-DISEASE AND SYSTEMIC HYPERTENSION

Ischemic heart disease (IHD) and systemic hypertension commonly coexis t in a large number of patients, and the presence of hypertension is c t risk factor for worsening IHD. A monotherapy that would effectively treat both is thus an attractive idea, and calcium antagonists have be en evaluated in this role. Calcium antagonists exert therapeutic effec ts through a combination of actions, including systemic and peripheral vasodilation, negative inotropy, and reduced nodal conduction. In ran domized, double-blind clinical trials, verapamil compares favorably wi th propranolol in the alleviation of angina and hypertension. Both dil tiazem and nifedipine, as well as long-acting diltiazem, are also effe ctive in Creating the combined condition. In addition, each of these d rugs enhances exercise tolerance and favors compliance with calcium an tagonist therapy. Recent questions regarding the safety of this class of drug have tempered the enthusiasm for their use as first-line thera py in cardiovascular disease. In particular, short-acting dihydropyrid ine derivatives, including nifedipine and isradipine, may increase car diovascular morbidity and mortality because of reflex sympathetic stim ulation. The results of appropriately controlled, prospective clinical trials will provide more definitive conclusions. For now, we must be cautious in the use of calcium antagonist monotherapy for combined IHD and hypertension. (C) 1997 by Excerpta Medico, Inc.