Therapeutic approaches to achieve desired blood pressure goals: focus on calcium channel blockers.

The new guidelines for blood pressure control recommended by the World Health Organisation, the International Society of Hypertension, and the JNC VI require that blood pressure be lowered to levels of < 130/85 mmHg in persons with either diabetes or renal insufficiency. A review of over 20 clinical trials performed over the last two decades indicates that an average of 62% of the participants required more than two medications to achieve a goal of < 140/90 mmHg. Thus, with the new guidelines it is clear that an even higher proportion of people will require at least two different medications to achieve this lower goal. Certain classes of antihypertensive medications are relatively more efficacious for lowering blood pressure in certain ethnic and racial groups, thus reducing the probability that two or more agents will be needed to achieve a stated blood pressure goal. This is exemplified by the effects of calcium channel blockers in African-Americans. However, even in these groups many require at least two different antihypertensive agents to achieve the blood pressure goal. The fixed-dose combinations of a calcium channel blocker and ACE inhibitor offer the advantages of complementary physiologic action, improved tolerability, lower side-effect profile, enhanced salutary effects on target organs, better compliance, and lower cost. Varieties of fixed-dose combination regimens for blood pressure lowering are available for clinical use. This article focuses on the subclasses of calcium channel blockers and their role in altering the natural history of both cardiovascular and renal disease. The article further discusses the role of fixed-dose agents with regard to their place in the antihypertensive armamentarium.