Although certain classes of drugs appear to possess benefits apart from their blood-pressure lowering capability, reduction of blood pressure remains the single most important action of
antihypertensive therapy.
Calcium-channel blockers (CCBs) have long been recognized as potent agents for
hypertension therapy. This is especially true for the prevention of
stroke in hypertensive patients as evidenced from the
Systolic Hypertension in Europe (Syst-Eur) and
Systolic Hypertension in China (Syst-China) trials with a long acting
dihydropyridine CCB. The same can be said for beta blockers in patients post
myocardial infarction. However, most recent clinical trials have underscored the necessity of multiple
drug therapy to achieve the goals of blood pressure reduction coupled with outcomes reduction. For example, the many recent large-scale clinical trials have required an average of three or more agents to achieve goal. Thus, the paradigm for
hypertension management has been altered to determine the best treatment regimen rather than the best initial agent. While response rates to individual agents across a wide spectrum of patients vary little, not all drugs are equally suited as companion products. In this article, we discuss the most recent outcome trials with the long acting CCBs alone or in combination with other drugs. The evidence shows that
calcium antagonists remain an important part of
hypertension management, including in those individuals at risk of cardiac and cerebrovascular events.