Calcium Antagonists Versus Beta-blockers in Hypertension Therapy should be individualised as they seem equally effective

As concern about the safety of diuretic treatment of hypertension grows and a decrease in coronary mortality associated with successful diuretic antihypertensive therapy has not been demonstrated, interest increases in the relative merits of ,S-blockers and calcium channel blockers as initial therapy for essential hypertension. Tests comparing verapamil, nifedipine and diltiazem with ,S-blockers have shown them to have similar antihypertensive efficacy, with ,S-blockers causing lower heart rates and lower systolic BP on exercise than the calcium channel blockers. Combination therapy has proved safe and effective with nifedipine and {3-blockers but verapamil and ,S-blockers should not be used together and more information is required about combinations with diltiazem.

From the results of the various trials it has been deduced that calcium antagonists may be useful for patients with bronchospastic conditions, peripheral vascular disease, insulin-dependent diabetes and left ventricular dysfunction while ,S-blockers may be appropriate for those with postural symptoms or oedema. Further, calcium antagonists may be more effective in the elderly and in Black patients while ,S-blockers seem more effective in young patients. Massie BM Ameflcan Journal of Cardiology 56 97H-100H 6 Dec 1985

2 INPHARMA"' 18 Jan 1986 0156-2703/86/1005-0002/0$0100/0 © AOIS Press