The safety of calcium-channel blockers.

Calcium-channel blockers are widely used as an effective treatment for hypertension and angina. Several studies have raised questions about their safety, suggesting that calcium-channel blockers can increase the rates of myocardial infarction (MI) and death, particularly in patients with heart disease. Reviews of these studies have uncovered serious methodological shortcomings or have found them restricted to short-acting drugs, frequently at high doses or used inappropriately. One study was based on old data regarding only short-acting nifedipine, which has never been indicated for patients who have suffered an MI or unstable angina. A case-control study of short-acting verapamil, diltiazem, and nifedipine suggested an increased MI rate was confounded by the higher rates of diabetes and preexisting heart disease in the patients treated with calcium-channel blockers. A third study reported significantly decreased survival only in patients taking short-acting nifedipine; in most of the cases reported, blood pressure was not controlled. While these studies alert us to the limitations of short-acting calcium-channel blockers and the necessity of considering side effects such as neurohormonal stimulation, a number of more recent, better-controlled studies have not confirmed increased risk with calcium-channel blockers when appropriately employed. Calcium-channel blockers should still be considered first-line therapy in appropriately selected patients with hypertension or angina.