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(Hypertension. 2001;37:1414.)
© 2001 American Heart Association, Inc.

Editorial Commentary

Arterial Calcification and Calcium Antagonists

What Does It Mean?

Murray Epstein; Henry R. Black

From the Division of Nephrology, University of Miami School of Medicine (M.E.), Fla; and the Department of Preventive Medicine, Rush-Presbyterian-St. Luke’s Medical Center (H.R.B.), Chicago, Ill.

Correspondence to Murray Epstein, MD, Nephrology Section, VA Medical Center, 1201 NW 16th St, Miami, FL 33125.

Key Words: coronary calcification • nifedipine • co-amilozide • computed tomography

	Introduction

 
Since their introduction more than 30 years ago, calcium antagonists have emerged as one of the most attractive and widely used classes of antihypertensive agents. Of the 20 to 25 million patients receiving medication for hypertension in the United States, about one quarter are taking calcium antagonists. The wide appeal of the calcium antagonists is attributable to several features, including efficacy in virtually all demographic groups, beneficial characteristics such as metabolic neutrality, and the occurrence of relatively few and primarily nuisance-type side effects.^{1 2} In addition, recent investigations have focused on their possible protective effects on target organs, such as the heart and kidney,^{3 4} further enhancing their value

Despite these attributes, a number of retrospective analyses have suggested that calcium antagonists may be detrimental and may promote adverse cardiovascular events. On the basis of this and other retrospective analyses, Pahor et al⁵ proposed that the use of calcium antagonists as first-line antihypertensive agents should be discontinued.

Although meta-analyses and observational studies clearly have limits, Pahor et al⁵ raised an important question that deserves consideration: whether calcium antagonists, as a group, promote adverse cardiovascular events, specifically coronary artery disease.⁶ Furthermore, media reporting of the presentation triggered concern among users of calcium antagonists and even among those taking other antihypertensive drug therapies.

Elsewhere in this issue, Motro et al⁷ report the results of a study that some have invoked as bearing on this controversy. These investigators attempted to assess the utility of ultra-fast computerized tomography (CT) to determine the difference between 2 drug . . . [Full Text of this Article]