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    Common Blood Pressure Drug May Not Be So Useful for Heart

    12/07/2000 continued...

    Jiang He, MD and Paul Whelton, MD, say these newer studies being reported this week "also provide support for the use of ACE inhibitors as initial choice of [blood-pressure-lowering] therapy. ACE inhibitors may be especially useful in patients who are at high risk of heart failure," they say. Some doctors favor combining ACE inhibitors with the older drugs and studies are in progress to determine how to best accomplish that goal.

    All the experts say, however, that the new studies should not be interpreted to mean that calcium-channel blockers are not useful drugs or that they are harmful. In fact, Pahor's study found them to be just as effective as the other drugs at lowering blood pressure. But, he says the other drugs may have additional benefits that calcium-channel blockers don't have, which is why they should always be used first. Calcium-channel blockers also appear to be fairly effective at reducing the risk of stroke among people with high blood pressure, so he and Whelton say one scenario in which they could be used as the initial treatment might be in people with a very high risk of stroke but a low risk of heart disease.

    Concerned patients taking calcium-channel blockers should talk with their doctors before stopping the use of calcium-channel blockers on their own.

    "The risk of abruptly stopping a medication -- such as a calcium-channel blocker -- is greater than continuing it until patients can go talk with their doctor about a particular study and consider changing it to a different blood pressure agent," says Norman Feinsmith, MD, FACC, a cardiologist at the University of Pennsylvania in Philadelphia.

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