Should dihydropyridines be used for first line treatment? The “CON” side

An antihypertensive effect of dihydropyridines (DHP) is well documented, but not a morbidity/mortality benefit. The assumption of a net clinical benefit of blood pressure lowering ignores the growing evidence of several secondary and unfavourable clinical effects linked to calcium antagonists. Moderate to high doses of DHP in particular appear to be harmful to patients with hypertension as well as coronary disease. Of concern are negative inotropic, proischemic, proarrhythmic and prohemorrhagic effects in certain subgroups of patients. Large long-term trials are urgently needed to assess efficacy and safety. Until convincing evidence documenting clinical benefit is available, it seems prudent to avoid DHP as first line treatment of hypertension.