Antihypertensive therapy and myocardial infarction: focus on calcium antagonists.

Effective antihypertensive therapy has recently been shown to reduce not only the incidence of stroke, but also myocardial infarction irrespective of the drug(s) used. The well-documented preventive effect of beta-blockers in patients who suffered a myocardial infarction (secondary prevention) cannot be extended to patients with hypertension without overt coronary artery disease (primary prevention), except perhaps for non-smoking men. Despite strong experimental evidence, information on a possible secondary preventive effect of calcium antagonists in man is scant, and two double-blind placebo-controlled trials in secondary prevention with verapamil (320 mg) in a total of 1436 patients and nifedipine (30 mg) in 2279 patients did not reveal an overall treatment benefit. There are another six on-going trials. In the management of hypertension, large-scale trials may never help in selecting a particular drug for cardiac event reduction, and probably for many years the goals will be to normalize blood pressure with increased emphasis on the need to remedy other cardiovascular risk factors, in particular smoking.