Calcium channel blockers in hypertension. Is there still a controversy?

There are several reasons why no single antihypertensive drug class is ideal in all clinical situations. First, pathophysiologic heterogeneity in hypertension and diversity of mechanisms of antihypertensive drugs dictate that no single drug class can be optimally effective in all subpopulations. Second, sustained blood pressure control generally requires combination therapy to block the reflex stimulation of physiologic mechanisms that attempt to restore blood pressure to pretreatment levels. Third, while effective blood pressure control is more important than choice of initial drug in the prevention of hypertension-related morbidity and mortality, specific drug classes are indicated for optimal treatment of complications of hypertension (e.g. heart failure, kidney disease). Fourth, although antihypertensive drug side effects are uncommon, alternative strategies are required in some patients. Given these principles, past controversies regarding whether calcium channel blockers (CCBs) should be used in the treatment of hypertension become moot. CCBs are extremely effective in lowering blood pressure and in preventing stroke and cardiovascular disease. When additional blood pressure lowering is necessary to meet strict targets, CCBs may be added, even in heart failure or chronic kidney disease, where CCBs alone may not achieve optimal outcomes. Combinations of CCBs with "anti-neurohumoral" drugs such as ACE inhibitors are particularly useful to achieve sustained blood pressure control, reduce adverse effects such as edema, and improve outcomes.