Popular Blood Pressure Medicine May Do More Harm Than Good
Furberg says the findings provide clear evidence that calcium channel blockers should not be the first drug that patients get for their high blood pressure. "We now have a large body of evidence from large, randomized trials and the evidence speaks for itself," Furberg tells WebMD.
"Our recommendation is that [the other blood pressure-lowering medicines] ... diuretics, beta-blockers, and ACE-inhibitors, remain the clear choice for ... hypertension. Due to their clinical inferiority and high costs, calcium channel blockers should be considered when [other standard] drugs have failed or cannot be tolerated. A few large, ongoing trials may modify the findings, but it is unlikely they will reverse them," Furberg says.
Milton Packer, MD, says that before we assume that all calcium channel blockers are inferior to other antihypertensives, more studies need to be performed. "I think Dr. Furberg has presented data here today that raise a concern about the use of [calcium channel blockers]. The definitive answer is not in place ... I think this is the first step in an evolving process to find out what truly represents first ... therapy [for hypertension]." Packer, a professor of medicine at the Columbia University College of Physicians and Surgeons in New York, did not participate in the study.
Robert Temple, MD, associate director of medical policy at the FDA's Center for Drug Evaluation and Research, tells WebMD that the FDA does not plan any immediate action on long-acting calcium channel blockers.
"At the moment, we don't know what studies are included in ... [this] analysis and don't know what the individual results were. When one looks at this, it may be that the results are largely driven by the results of one study, so we don't have the answers yet ... We just can't act on rumors," he says, adding that the FDA will await publication of the results before acting.
"There have been lots of claims about calcium channel blockers in the past," Temple tells WebMD, but those claims, he says, "were based on observational data which were absolutely unreproducible." Pahor and his colleagues also did those studies. Pahor says the criticism of those early trials prompted the decision to do this more extensive analysis.
"I would hate to think that these drugs would be stopped because people think there is something wrong with the drugs, or because they think the drugs are dangerous," says Temple.
Medical experts agree and urge caution to patients considering stopping their blood pressure medicine due to this one study. In a press release from Wake Forest, Bruce M. Psalty, MD, PhD, a co-author of the new study and a professor of medicine, epidemiology, and health services at the University of Washington, said: "In all instances, patients should consult their physicians about any potential changes in their antihypertensive therapy. If patients are not taking a proven therapy such as low-dose diuretics, it is reasonable for them to ask their physicians, 'Why not?'"