Heart rate-lowering calcium antagonists in hypertensive post-myocardial infarction patients

Franz H. Messerli, Jørgen Fischer Hansen, Robert S. Gibson, Kenneth B. Schechtman, William E. Boden

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12 Scopus citations

Abstract

Objectives To analyse effects of a heart rate-lowering calcium antagonist in hypertensive post-myocardial infarction patients. Design and methods From three large, randomized, placebo-controlled, secondary prevention trials investigating verapamil or diltiazem (the first and second Danish Verapamil Infarction Trials and the Multicentre Diltiazem Post-Infarction Trial) data from a total of 1325 hypertensive post-myocardial infarction patients (drugs = 667, placebo = 658) were pooled to assess effect of blinded therapy on mortality and event rates. Results Treatment with heart rate-lowering calcium antagonists was associated with significant reduction in event rates [21.4 versus 27.4%; risk ratio (RR) = 0.76, confidence interval (CI) = 0.61-0.95, P = 0.013]. Mortality rates in the treatment group were 15.1 versus 17.5% in the control group (RR = 0.87, CI = 0.66-1.13, P = 0.296). Among the subset of 964 hypertensive patients without pulmonary congestion, there was some reduction in mortality rate (11.3 versus 15.3% in the control group; RR = 0.72, P = 0.066) and significant reduction in event rates (18 versus 24.4% for control group; RR = 0.70, P = 0.011). In patients with pulmonary congestion and hypertension, however, calcium antagonists were associated with a 25% increase in mortality (RR = 1.25, P = 0.339), while event rate RR was 1.00. After an adjustment for significant covariates, RR for mortality in treatment versus control groups was 0.76 (P = 0.159). For event rates, RR was 0.74 (P = 0.057). Conclusions Heart rate-lowering calcium antagonists decrease event rates in hypertensive post-myocardial infarction patients, but only in those without pulmonary congestion.

Original languageEnglish
Pages (from-to)977-982
Number of pages6
JournalJournal of Hypertension
Volume19
Issue number5
DOIs
StatePublished - Jan 1 2001

Keywords

  • Calcium antagonists
  • Coronary artery disease
  • Hypertension
  • Myocardial infarction

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