Calcium Antagonists in the Treatment of Essential Hypertension

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Abstract
The purpose of the present article is to review a number of studies dealing with the efficacy of calcium antagonists, in particular verapamil, in the treatment of essential hypertension. Several well-controlled studies have shown that verapamil causes a significant decrease in both systolic and diastolic pressure. Blood pressure decrease, which is of the same magnitude as with propranolol, is related to pretreatment values and, according to some authors, to age, but the latter statement is being refuted by others. Using a slow-release preparation, it can be shown that the 24-h blood pressure profile with once-daily administration is quite similar to the profile seen with three-times-daily administration of the regular formulation of verapamil. It has also been documented that the blood pressure decrease persists during 1-year continued administration. Optimal effect is seen at 240-320 mg/day. The most frequent side effects are constipation, flushing, and conduction disturbances. It is often proposed that the addition of a diuretic to verapamil does not increase the antihypertensive effect, but recent studies provide evidence to the contrary. Finally, ambulatory pressure recordings have shown that nifedipine does not decrease blood pressure variability. In general, calcium antagonists seem to be effective antihypertensive drugs but their place in the daily antihypertensive treatment has still to be defined.

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