| We analyzed the available data to assess the effects of calcium antagonists
in hypertensive patients with diabetes mellitus.We performed a MEDLINE
search of English-language articles published until April 2003, using
the terms diabetes mellitus, hypertension or blood pressure, and therapy.
Pertinent articles cited in the identified papers were also reviewed.
We included prospective randomized studies of more than 12 months'
duration that evaluated the effect of drug treatment on morbidity and
mortality in diabetic patients with hypertension. We estimated the
effect of treatment with calcium antagonists on morbidity and mortality
in comparison with placebo, conventional therapy, and therapy that
blocks the renin-angiotensin system.We identified 14 studies that reported
outcomes in diabetic hypertensive patients. Compared with placebo,
calcium antagonists reduced cardiovascular morbidity and mortality.
Compared with conventional therapy, calcium antagonists had similar
effects on coronary heart disease and total mortality, but may have
reduced the risk of stroke (odds ratio [OR] = 0.87; 95% confidence
interval [CI]: 0.74 to 1.02; P = 0.08). However, they resulted in a
lesser reduction of the risk of heart failure (OR = 1.33; 95% CI: 1.17
to 1.50). Calcium antagonists were less effective than blockers of
the renin-angiotensin system in preventing heart failure (OR = 1.43;
95% CI: 1.10 to 1.84), but had similar effects on stroke, coronary
heart disease, and total mortality.Calcium antagonists are safe and
effective in reducing most types of cardiovascular morbidity and mortality
in diabetic hypertensive patients, although their use is associated
with a lesser reduction of risk of heart failure as compared with other
treatments for hypertension. |
