The results of 2 recently published studies have been interpreted as suggesting that
calcium antagonists are unsafe for the management of
hypertension in patients with diabetes. These 2 studies, the
Fosinopril versus
Amlodipine Cardiovascular Events Randomized Trial (FACET) and Appropriate Blood Pressure Control in Diabetes (ABCD), showed that
angiotensin-converting enzyme (
ACE) inhibitors may be preferable to
calcium antagonists for managing
hypertension in diabetic patients; they do not, however, show any harm attributable to
calcium antagonists. Indeed, results of the FACET study suggest that the combination of an
ACE inhibitor and a
calcium antagonist is effective
antihypertensive therapy. This suggestion is supported by findings in the
Systolic Hypertension in Europe (Syst-Eur) Study, which revealed outstanding benefits of either a
calcium antagonist alone or a
calcium antagonist combined with an
ACE inhibitor among diabetic patients with
hypertension. The premature termination of the hypertensive arm of the ABCD study was puzzling because, although 2 of 13 subgroups of 1 of the 5 possible secondary endpoints in this part of the trial were apparently favorably affected by the use of the
ACE inhibitor rather than the
calcium antagonist, such a finding was compatible with chance alone. If the results of the FACET and ABCD studies are considered in the context of the best available data arising from large randomized controlled trials, one may conclude that
calcium antagonists are not harmful or contraindicated in hypertensive patients with diabetes and that the combination of an
ACE inhibitor and a
calcium antagonist is effective for the management of
hypertension in diabetic patients.