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Review: calcium antagonists lead to a higher risk for myocardial infarction, congestive heart failure, and major cardiovascular events

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 QUESTION: In patients with hypertension, are calcium antagonists (CAs) as first line treatment superior, equal, or inferior to other antihypertensive drugs for reducing major cardiovascular events?

Data sources

Studies were identified by searching Medline up to September 2000, the US National Library of Medicine clinical trials database, and the Cochrane Library; by reviewing reference lists of identified articles; and by contacting colleagues.

Study selection

Studies were selected if they were randomised controlled trials published in peer reviewed journals that included >100 patients with hypertension who were allocated to first line treatment with a CA or other antihypertensive agent and who were followed for ≥2 years for the assessment of cardiovascular events.

Data extraction

Data were extracted on drug type and dose, patient characteristics, and main outcomes. Summary data were pooled.

Main results

9 trials involving 27 743 patients with about 120 000 person years of follow up met the selection criteria. CAs and other antihypertensive agents led to similar reductions in blood pressure. Patients …

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  • Source of funding: not stated.

  • For correspondence: Professor M Pahor, Sticht Center on Aging, Department of Internal Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. Fax + 1 336 713 8588.