Hypertension and Mortality

It has been shown that regular treatment and care in combination with an antihypertensive drug therapy will reduce mortality in patients with hypertension (20). There are a variety of antihypertensive drugs on the market and which one is prescribed is based on a number of factors. These include the patient's race, gender, genetic background, the presence or absence of organ damage or other diseases, cost, convenience, and tolerance for the drug. One of the most popular and controversial drug therapies available include calcium channel blockers.

Calcium channel blockers were first developed in 1962 for the treatment of angina (6). Later research discovered that they work by interfering with the influx of calcium ions into the heart and vascular smooth muscle needed for heart muscle contraction. This in turn lowers blood pressure by reducing cardiac output and peripheral resistance (3).

There are three classes of calcium channel blockers which differ in their receptor types within the calcium channel (4). The first group consists of the diphenylalkylamines or the verapamil-like agents. The second group includes the benzothiazepines or diltiazem-like agents. The third group is made up of the dihydropyridines such as nifedipine, nisoldipine, nicardipine, nimodipine, isradipine, amlodipine, and felodipine. (4). The dihydropyridines, in turn, are further divided into subclasses according to their effects on contractility.

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rtality in patients with MI or unstable angina" (11). The Alderman et al. study above which compared 189 patients with histories of cardiovascular events or disease with a control group did find that short-acting calcium channel blockers did significantly increase the risk of another cardiovascular event but that the long-acting calcium channel blockers did not. The Prospective Randomized Amlodipine Survival Evaluation (PRAISE) study showed that amlodipine besylate benefitted dilated cardiomyopathy and safety in ischemic cardiomyopathy (11). "PRAISE reported no increase in either death or serious cardiovascular morbidity with the long-acting dihydropyridine amlodipine" (15). Indeed, this group even indicated a trend to reduce the relative risk of mortality (8). DEFIANT II supported this finding in addition to documenting no increase in adverse cardiovascular outcomes (15). CRIS findings included an almost equal number of deaths between the verapamil group (30 deaths) and the placebo-control deaths (28 deaths) after a two-year follow-up (15). The same was true of reinfarctions with the verapamil group having 39 and the placebo group 49 (15). So while the majority of the studies seem to support the theory that short-acting

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