Arterial calcification and calcium antagonists: what does it mean?

Abstract

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 …