Should calcium antagonists be first line drugs in hypertension

: The goal of the treatment of hypertension is to reduce the risk of the cardiovascular complications--stroke, acute myocardial infarction, congestive heart failure and renal dysfunction--not just to lower an elevated blood pressure. There are no completed large long-term clinical trials of calcium antagonists--short-acting or long-acting--designed to assess their efficacy and safety in patients with hypertension. Two smaller trials of dihydropyridines have suggested that despite blood pressure control, there may be a paradoxical increase in cardiovascular complications. These adverse effects are similar to those reported from clinical trials of short-acting calcium antagonists in coronary patients. Due to concerns about their long-term safety, inadequate documentation of their long-term efficacy and their high cost, calcium antagonists should be reserved as third-line agents. If prescribed, they should be given in low doses, possibly in combination with another antihypertensive agent. Their use should be limited to patients who cannot tolerate the other proven agents such as diuretics and beta-blockers, and to those who are not controlled on these agents or those with relative or absolute contraindication to them.