Antiatherosclerotic and vasculoprotective effects of calcium antagonists: clinical implications.

Clinical experience and epidemiological observations have demonstrated that some hypertensive patients experience progression of atherosclerotic vascular disease despite successful control of hypertension. Thus, there appears to be a discordance relative to the benefits of antihypertensive therapy--'pressure'-related but not 'atherosclerotic' complications are prevented by BP control with conventional antihypertensive therapy. The effects of antihypertensive drugs on atherosclerotic complications of hypertension is a subject of major clinical importance. The question is whether or not different classes of antihypertensive drugs exert dissimilar vasculoprotective actions independent of their BP lowering effects. There is considerable experimental data to implicate a relationship between calcium and lipoprotein metabolism at the vascular site. The calcium ion may play a role in the steps culminating in the formation of atherosclerotic plaques. Evidence has been presented that calcium channel blockers may modify experimental arterial calcinosis and atherosclerosis. At least a couple of published trials have shown that calcium antagonists indeed prevent/attenuate atherosclerotic lesions in patients with coronary artery disease. These observations underscore the significance of a new dimension in cardiovascular drug therapy--that is the vasculoprotective and antiatherosclerotic effects of calcium antagonists.