Primary prevention potential of the calcium antagonists. Effects on blood pressure and lipid pattern.

Untreated hypertension has a variety of serious consequences, such as stroke, congestive heart failure and coronary heart disease, the incidences of which escalate sharply in the presence of other risk factors. Traditional antihypertensive therapy has been associated with reductions in the frequency of strokes, congestive heart failure and kidney failure, but a corresponding decline in myocardial infarctions has not been observed. Deleterious changes in lipid metabolism that are induced by these agents may counteract the beneficial effects of blood pressure reduction. Calcium antagonists have been used successfully in the management of hypertension for more than a decade. To define the impact of the calcium antagonist verapamil on metabolic parameters, 45 hypertensive patients were treated with verapamil monotherapy and followed up for 4 to 8 years. After a mean treatment period of 5.3 years, total cholesterol and triglycerides were unchanged, whereas mean high density lipoprotein (HDL) cholesterol increased significantly, from 1.17 +/- 0.41 to 1.39 +/- 0.36 mmol/L (p less than 0.05). Other important biochemical parameters were unaffected by verapamil therapy. The primary target organs of hypertension are the arterial system and the myocardium. Accumulating literature now suggests that the calcium antagonists may represent an effective therapeutic approach to hypertension that controls both the pressure-related and atherosclerotic complications.