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Therapeutic Controversies

Winnie Zing, PharmD; Roger K. Ferguson, MD; Peter H. Vlasses, PharmD

Arch Intern Med. 1991;151(11):2154-2162.

Abstract
Calcium antagonists are now recommended as monotherapy for the treatment of mild to moderate essential hypertension by the Joint National Committee (JNC) on the Detection, Evaluation, and Treatment of High Blood Pressure. Based on a statement in the 1988 JNC report that black and elderly patients tend to respond better to calcium antagonists, we reviewed the literature to examine the predictive value of age and race to the antihypertensive response of calcium antagonists. The majority of studies we reviewed failed to substantiate the JNC statement and wellpromulgated reports in the literature suggesting preferential action of calcium antagonists in the elderly, or their superiority when compared with diuretics, βadrenergic blockers, and angiotensin-converting enzyme inhibitors. Although not noted by the JNC, pretreatment blood pressure appeared to be an important predictor of the antihypertensive response to calcium antagonists. The literature reviewed indicates that calcium antagonists have comparable efficacy in black and white hypertensive patients. However, the limited comparative studies reviewed support the JNC statement that, as with diuretics, blacks have a greater antihypertensive response with calcium antagonists than with βadrenergic blockers or angiotensin-converting enzyme inhibitors.

(Arch Intern Med. 1991;151:2154-2162)

Author Affiliations
From the Department of Pharmacy, Thomas Jefferson University Hospital, Philadelphia, Pa (Dr Zing); University of Nevada, Reno (Dr Ferguson); and Division of Clinical Pharmacology, Department of Medicine, Jefferson Medical College, Philadelphia (Dr Vlasses).

Footnotes
Accepted for publication December 31, 1990.

Reprint requests to Department of Pharmacy, Crozer-Chester Medical Center, 1 Medical Center Blvd, Upland, PA 19013-3995 (Dr Zing).

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