Calcium Antagonist Controversies

Part of the Contemporary Cardiology book series (CONCARD)


Calcium antagonists without doubt cause an increased incidence of heart failure (HF) as observed in several well-run randomized controlled trials (RCTs):
  • Amlodipine in Antihypertensive and Lipid-Lowering Treatment (ALLHAT): HF 38% versus diuretic (1).

  • Nifedipine in Intervention as a Goal in Hypertension Treatment (INSIGHT): HF 46% versus diuretic (2).

  • Verapamilin Controlled Onset Verapamil Investigation of Cardiovascular EndPoints (CONVINCE): HF 30% (3).

  • Amlodipine in Prospective Randomized Amlodipine Survival Evaluation (PRAISE) caused significant increased pulmonary edema in patients with left ventricular (LV) dysfunction (4).

  • Diltiazem caused a significant increase in HF in a non-Q-wave infarction study (5).


Calcium Antagonist Sick Sinus Syndrome Verapamil Sustained Release Hydrochlorothiazide Group Prior Heart Failure 
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  1. 1.
    The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major out-comes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288:2981–2997.CrossRefGoogle Scholar
  2. 2.
    Brown MJ, Palmer CR, Castaigne A, et al. Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment. Lancet 2000;356:366–372.PubMedCrossRefGoogle Scholar
  3. 3.
    CONVINCE: Black HR, Elliott WJ, Grandits G, et al. for the CONVINCE Research Group. JAMA 2003; 289:2073–2082.PubMedCrossRefGoogle Scholar
  4. 4.
    Packer M, O’Connor CM, Ghali JK, et al. Effect of amlodipine on morbidity and mortality in severe chronic heart failure: For the Prospective Randomised Amlodipine Survival Evaluation Study Group. N Engl J Med 1996;335:1107.PubMedCrossRefGoogle Scholar
  5. 5.
    Multicenter Diltiazem Postinfarction Trial Research Group. The effect of diltiazem on mortality and reinfarction after myocardial infarction. N Engl J Med 1989;319:385.Google Scholar
  6. 6.
    INVEST: Pepine CJ, Handberg EM, Rhonda M, et al. for the INVEST Investigators. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): A randomized controlled trial. JAMA 2003;290: 2805–2816.PubMedCrossRefGoogle Scholar

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© Humana Press Inc., Totowa, NJ 2007

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