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Healthy Heart Reports

Calcium Channel Blockers

Calcium channel blockers are classified as short, intermediate, and long acting. Previous studies showed that short-acting calcium channel blockers can increase risk for heart attacks (4). Older studies showed that short and intermediate acting calcium channel blocker may increases risk for heart attacks, and a recent study shows that longer acting calcium channel blockers also may also cause heart attacks (5). There are not enough studies to prove that calcium channel blockers cause heart attacks, but the studies are suggestive enough for most doctors to reserve them for special cases. Most short-acting calcium channel blockers have been taken off the market, and replaced by the longer-acting ones that have not been associated with increased risk for heart disease.

Bruce Psaty of the University of Washington in Seattle reports that calcium channel blocker users are 58 to 70 percent more likely to suffer heart attacks than people who take just diuretics (1). Therefore the Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure recommends the first treatment of beta blockers and diuretics, except for smokers and people with lung disease because beta blockers can block the bronchial tubes. If this combination is not effective, calcium channel blockers, ACE inhibitors and alpha blockers are the next choices. An editorial in the same issue recommends that patients taking calcium channel blockers continue to do so. Calcium channel blockers include Adalat, Calan, Cardizem, Dilacor, Isoptin, Procardia and Verelan. Beta blockers include Betapace, Blocadron, Brevibloc, Cartrol, Corgard, Inderal, Kerlone, Levatol, Lopressor, Sectral and Tenormin.

Previous studies show that more than 60 percent of adult hypertensives can have their blood pressures return to normal just by going on a low-fat, high-fiber diet and losing weight and that single drugs return high blood pressure to normal less than 40% of the time. So, all people with high blood pressure should go on low fat, high fiber diets, lose weight,/ avoid smoking and being overweight/ and start a controlled exercise program. There are five type of drugs commonly used to treat high blood pressure: diuretics, beta-blockers, angiotensin converting enzyme (ACE) inhibitors, calcium antagonists and alpha, beta blockers. Many recent papers show that potassium-losing diuretics, such as Lasix and Diuril, may increase the incidence of heart attack deaths and that short and moderate-acting calcium channel blockers, might increase the occurrence of coronary heart disease. Beta blockers, such as Inderal, can make a person very tired, raise blood sugar and cause weight gain. ACE inhibitors, such as Vasotec, can cause a chronic cough in one of every 5 people who take them and alpha, beta blockers, such as Normodyne and Trandate, can make a person dizzy. Here are choices: 1) lisinopril 10 to 20 mg once a day (ace inhibitor). 2) lisinopril 10 QD plus hydrochlorothiazide 12.5 mg (Prinzide) I or II /day. 3) terazosin 1 or 2 mg once a day. (adrenergic blocker) Hytrin. 4) labetalol (Trandate) 100mg BID (not for asthma).

1)The Journal of the American Medical Association. August 22, 1995. first presented by Dr. Psaty at the American Heart Association, Epidemiology Section, meeting in San Antonio, Texas March 10, 1995.

2) AL Fitzpatrick, JR Daling, CD Furberg, RA Kronmal, JL Weissfeld. Use of calcium channel blockers and breast carcinoma risk in postmenopausal women. Cancer 80: 8 (OCT 15 1997):1438-1447.

3) EW Dong, JE Connelly, SP Borden, W Yorzyk, DG Passov, B Kupelnick, DH Luo, SD Ross. A systematic review and meta-analysis of the incidence of cancer in randomized, controlled trials of verapamil. Pharmacotherapy 17: 6(NOV-DEC 1997):1210-1219. no statistically significant increased risk of cancer or deaths with verapamil.

4) JAMA September 10, 1996.

5) New England Journal of Medicine 1998;338:645-652.

6) J Chalmers. Treatment guidelines in hypertension: Current limitations and future solutions. Journal of Hypertension 14: Suppl. 4 (NOV,1996):S3-S8.

1/24/02

Copyright 2002 www.DrMirkin.com
Dr. Mirkin's opinions and the references cited are for information only, and are not intended to diagnose or prescribe. For your specific diagnosis and treatment, consult your doctor or health care provider.

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