The Anti-hypertensive Drug Therapy

Generally they possess been comprise to effectively lower blood pressure, have few untoward side effects, and be generally well-tolerated by those who take them unheeding of age, race, or sex. Due to this and the fact that they have been heavily promoted, they be angiotensin converting enzyme of the more prescribed antihypertensive drugs. Their enforce change magnitude from 33% in 1992 to 38% in 1995 (22). Despite their popularity, however, in that respect has been controversy surrounding their use, much of which centers around the effect of short-acting atomic number 20 passage blockers on the message.

"The goal of treating high blood pressure is to reduce clinical events, non simply to lower blood pressure. Therefore, when choosing pharmacologic therapy, one must look at all the effects produced by a given agent" (11). There have been a variety of studies using various calcium pass on blockers to squ ar this effect on those who take them.

A group of studies have documented the potential difference negative effects. Psaty et al. found that the short-acting dihydropyridines could cause workable harm while the long-acting calcium channel blockers remained unseasoned (19). Another study by Alderman et al. studied 189 patients who had had a separatrix or heart attack and 189 patients who had not and found that long-acting calcium channel blockers were not associated with stroke or heart attack but that short-acting calcium channel blockers increased the find almost four-fold (1). In the

Multicenter Isradipine diuretic drug Atherosclerosis Study, it was found that in patients who stickd calcium channel blockers, major cardiovascular events increased by 80% as compared to those who received hydrochlorothiazide (11). The Evaluation Group of Long-term antihypertensive Treatment documented a higher risk of cerebrovascular accident with the use of dihydropyridine calcium channel blockers over the use of an ACE inhibitor (11). Paher et al. compared mortality rates among 206 elderly persons treated for hypertension and established that those taking nifedipine had a 70% great all-cause mortality over the group taking a of import blocker (11). Furberg at al.

completed a meta-analysis of randomized trials of short-acting nifedipine in patients with CAD and found the drug to be associated with 15% excess mortality compared with the placebo group (11). Dr. Furberg also noted potential harms to include proischemic, negative inotropic, proarrhythmic, and prohemorrhagic effects in addition to just about marked hypotension (11).

(2) Calcium antagonist antihypertensive therapy reduces strokes. (1997). Geriatrics, 52, 23-25.

There are, however, well-nigh problems that have been noted with some of the studies decrying the use of calcium channel blockers either short- or long-acting. A University of Washington study which to begin with cautioned against the use of these antihypertensive agents was found to be misleading when the unfeigned risk of increased heart attack was found to be an insignificant 1.6%. In the 1995 Psaty et al. case-control study which started the controversy, it must be remembered that hypertensive patients with CAD or other concomitant disorders are inherently at a greater risk for myocardial infarction (MI) death and that they are the patients who are more likely to receive calcium channel blockers (11). It was also noted that the analysis was not controlled for left ventricular dysfunction or ventricular arrhythmias which are common in patients with
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