Review of the Available Evidence about Nifedipine in the Treatment of Hypertension

Findings from a meta-analysis published in 1995 suggested that in the secondary prevention of myocardial infarction, short-acting nifedipine in moderate to high doses causes an increase in total mortality. Several plausible explanations for this adverse outcome have been suggested, including a proischaemic effect, a negative inotropic effect, marked hypotension, and proarrthythmic effects. A prohemorrhagic effect attributed to antiplatelet and vasodilatory actions of calcium channel blockers has also been reported. More recently, in two case-control studies an increased risk of cardiovascular events in hypertensive patients treated with short-acting calcium channel blockers was found. As a result, in 1997 the VI Report of the Joint National US Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure recommended avoiding the use of short-acting calcium channel blockers in patients with hypertension and angina pectoris. At that time, data for long-acting calcium channel blockers were scarce, but in 1996-2004 several trials have been published which deserve attention.