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Calcium antagonists should continue to be used for first-line treatment of hypertension.

OVER THEpast 20 years, calcium antagonists have emerged as one of the most attractive and widely used classes of antihypertensive agents. This is attributable to several features that include their efficacy, metabolic neutrality, relatively few side effects, and possible protective effects on target organs such as the kidney. 1-3 Despite these attributes, a number of retrospective analyses have suggested that calcium antagonists may be detrimental and may promote adverse cardiovascular events. The first meta-analysis 4 on the effects of 1,4-dihydropyridines on outcome included 21 clinical trials and suggested an adverse trend on mortality (365 of 4731 in the-treated patients vs 330 of 4733 control patients; odds ratio, 1.13; and 95% confidence interval [CI], 0.97 to 1.32) and the development of subsequent myocardial infarction (124 of 3645 treated patients vs 111 of 3680 control patients; odds ratio, 1.14; and 95% CI, 0.68 to 1.92). Recently, Psaty et al 5 presented