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Vivian M. Abascal, MD; Martin G. Larson, ScD; Jane C. Evans, MPH; Ana T. Blohm, BA; Kim Poli, MD; Daniel Levy, MD

Arch Intern Med. 1998;158:1882-1886.

Background  Several recent studies have suggested that calcium antagonist drugs, which are widely used for the treatment of hypertension, are associated with increased risk of cardiovascular disease. These studies have cast doubts on the long-term safety of calcium antagonists.

Objective  To examine the association of calcium antagonist use with mortality in subjects with hypertension followed up in the Framingham Heart Study.

Subjects and Methods  We stratified 3539 subjects (mean±SD age, 64±13 years) from the Framingham Heart Study who had hypertension at routine clinic examinations, according to the use of calcium antagonists and presence of coronary heart disease at the baseline examination. At each follow-up examination (every 2-4 years), subjects were reclassified with regard to the use of calcium antagonists. The end point of the study was all-cause mortality. Hazard ratios and 95% confidence intervals associated with the use of calcium antagonists were obtained using Cox proportional hazards regression models.

Results  There were 970 deaths during follow-up. Hazard ratios for mortality associated with the use of calcium antagonists were 0.93 (95% confidence interval, 0.72-1.21; P =.59) for subjects with hypertension without coronary heart disease, and 0.92 (95% confidence interval, 0.69-1.24; P =.58) for those with coronary heart disease at baseline. All models were adjusted for age, sex, current smoking, systolic and diastolic blood pressure, use of -blockers, and use of other antihypertensive medications.

Conclusions  In this cohort of 3539 subjects with hypertension there were no differences in mortality among subjects with hypertension using a calcium antagonist compared with those who were not. Results were similar among subjects with hypertension with and without coronary heart disease. The results of ongoing long-term, randomized clinical trials will provide more definitive data on the safety of calcium antagonists.

From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass (Drs Abascal, Larson, Poli, and Levy and Mss Evans and Blohm); the Department of Mathematics (Dr Larson and Ms Evans) and the Divisions of Cardiology and Preventive Medicine (Drs Abascal and Levy), Boston University School of Medicine, Boston, Mass; the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (Dr Levy); and the National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Levy).

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