Effect of long-acting and short-acting calcium antagonists on cardiovascular outcomes in hypertensive patients

• Published in: The Lancet (British edition) 1997-03, Vol.349 (9052), p.594-598
• Main Authors: Alderman, Michael H, Cohen, Hillel, Roqué, Rosemarie, Madhavan, Shantha
• Format: Article
• Language: English
• Subjects: Antihypertensive Agents - administration & dosage; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Calcium; Calcium Channel Blockers - administration & dosage; Calcium Channel Blockers - adverse effects; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - mortality; Case-Control Studies; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Cohort Studies; Drug therapy; Drug Therapy, Combination; Female; Humans; Hypertension; Hypertension - drug therapy; Logistic Models; Male; Medical sciences; Middle Aged; Odds Ratio; Regression Analysis; Risk; Treatment Outcome
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(96)08359-6

Short-acting calcium antagonists may increase coronary artery morbidity, mortality, and non-cardiovascular complications in hypertensive patients. We assessed whether this association was also true for long-acting calcium antagonists. We did a case-control study, which was nested within a systematic hypertension control programme for a prospective cohort of 4350 people (first seen 1981–94). Cases (n=189) were hypertensive patients who had had a first cardiovascular event, including all cardiovascular deaths and hospitalisations, between 1989 and 1995. Controls (n=189) were individually matched to cases for sex, ethnic origin, age, type of previous antihypertensive treatment, year of entry into the study, and length of follow-up. We collected data on any prescribed drug regimen that was being taken on the event date for cases and on the same date for matched controls. Calcium antagonists were classified by duration of action. Compared with those on β-blocker monotherapy, patients on long-acting calcium antagonists (n=136) had no increased risk of a cardiovascular event (adjusted odds ratio 0·76 [95% CI 0·41–1·43]), whereas patients on shortacting calcium antagonists (n=27) were at significantly greater risk (adjusted odds ratio 3·88 [1·15–13·11], p=0·029). Among 38 matched pairs who were both on calcium antagonists, the adjusted risk ratio for short-acting versus long-acting was 8·56 (1·88–38·97), p