It is amply recognized that blood pressure control remains far removed from the goals recommended by international guidelines [1,2]. Rarely is a blood pressure control above 30% (with a goal of no less than 140/90 mmHg) seen in clinical settings [3].

Hospital-based hypertension units have witnessed values above 40% [4], and some clinical trials (for example, the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial [ALLHAT] [5]) have noted control values as high as 60%. According to international guidelines, if a goal lower than 130/80 mmHg was considered in hospitalbased hypertension units or in clinical trials (eg, when associated clinical conditions, diabetes, and chronic kidney disease are present), an adequate blood pressure control would be less than 20%.

In order to achieve a goal close to that proposed by the international guidelines, many drugs have been formulated. One such class-calcium channel blockers-are widely used for the treatment of cardiovascular disease, particularly angina pectoris, arrhythmias, and arterial hypertension. The three main classes of calcium channel blockers in current use are the benzothiazepines (diltiazem), phenylalkylamines (verapamil), and dihydropyridines (nifedipine, amlodipine, and others). Their beneficial effects are related to systemic vasodilation caused by the inhibition of the inward flow of calcium ions through the L-type calcium channels in the cell membrane. In hypertensive patients with or without chronic kidney disease, calcium channel blockers are excellent antihypertensive drugs. Moreover, considering that a high percentage of patients will require combination therapy to achieve an adequate blood pressure goal, dihydropyridine calcium channel blockers offer their synergistic blood-pressure-lowering effects with different antihypertensive agents.


 

 

 

REFERENCES

^1.  Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003;289:2560-2571.

2. The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). 2007 Guidelines for the Management of Arterial Hypertension. J Hypertens 2007;25:1105-1187.

3. Borghi C, Dormi A, D'Addato S, Gaddi A, Ambrosioni E; and the Brisighella Heart Study Working Party. Trends in blood pressure control and antihypertensive treatment in clinical practice: the Brisighella Heart Study. J Hypertens 2004;22:1707-1716.

4. Banegas JR, Segura J, Ruilope LM, et al, on behalf of the CLUE Study Group Investigators. Blood pressure control and physician management of hypertension in hospital hypertension units in Spain. Hypertension 2004;43:1338-1344.

5. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA 2002;288:2981-2997.