Calcium antagonists in hypertension: first-line antihypertensive agents?

The treatment of hypertensive patients with calcium antagonists favourably influences cardiovascular risk factors as well as the progression of cardiovascular disease. In ongoing large-scale intervention trials, several calcium antagonists are also under investigation for their potential ability to reduce cardiovascular morbidity and mortality in hypertensive patients. The calcium antagonists as a group are heterogeneous, and the haemodynamic effects may vary in accordance with several factors, e.g. vascular selectivity, pharmacokinetic properties, dose schedule and formulation and route of administration. Compared with the older agents, some of the newer dihydropyridines, such as manidipine, have a less negative inotropic effect and less potential for consistent neurohumoral activation.