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Previous Volume 338:645-652 March 5, 1998 Number 10 Next

	Full Text PDF Editorial by Cutler, J. A. Letters Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article PubMed Citation

ABSTRACT

Background It has recently been reported that the use of calcium-channel blockers for hypertension may be associated with an increased risk of cardiovascular complications. Because this issue remains controversial, we studied the incidence of such complications in patients with non-insulin-dependent diabetes mellitus and hypertension who were randomly assigned to treatment with either the calcium-channel blocker nisoldipine or the angiotensin-converting–enzyme inhibitor enalapril as part of a larger study.

Methods The Appropriate Blood Pressure Control in Diabetes (ABCD) Trial is a prospective, randomized, blinded trial comparing the effects of moderate control of blood pressure (target diastolic pressure, 80 to 89 mm Hg) with those of intensive control of blood pressure (target diastolic pressure, 75 mm Hg) on the incidence and progression of complications of diabetes. The study also compared nisoldipine with enalapril as a first-line antihypertensive agent in terms of the prevention and progression of complications of diabetes. In the current study, we analyzed data on a secondary end point (the incidence of myocardial infarction) in the subgroup of patients in the ABCD Trial who had hypertension.

Results Analysis of the 470 patients in the trial who had hypertension (base-line diastolic blood pressure, >90 mm Hg) showed similar control of blood pressure, blood glucose and lipid concentrations, and smoking behavior in the nisoldipine group (235 patients) and the enalapril group (235 patients) throughout five years of follow-up. Using a multiple logistic-regression model with adjustment for cardiac risk factors, we found that nisoldipine was associated with a higher incidence of fatal and nonfatal myocardial infarctions (a total of 25) than enalapril (total, 5) (risk ratio, 9.5; 95 percent confidence interval, 2.3 to 21.4).

Conclusions In this population of patients with diabetes and hypertension, we found a significantly higher incidence of fatal and nonfatal myocardial infarction among those assigned to therapy with the calcium-channel blocker nisoldipine than among those assigned to receive enalapril. Since our findings are based on a secondary end point, they will require confirmation.

Source Information

From the Colorado Prevention Center (R.O.E., B.W.J., W.R.H., S.L.B., N.G., R.W.S.); the Division of General Internal Medicine (R.O.E.), the Division of Renal Diseases and Hypertension (B.W.J., N.G., R.W.S.), the Divisions of Geriatrics and Cardiology (W.R.H.), Department of Medicine, and the Section of Vascular Medicine (W.R.H.), University of Colorado Health Sciences Center; and the Department of Community Health Services, Denver Health (R.O.E.) — all in Denver.

Address reprint requests to Dr. Schrier at the Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Health Sciences Center, 4200 E. Ninth Ave., Box B-178, Denver, CO 80262.

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