Why calcium channel blocker vs beta blocker?

Q: Is a calcium channel blocker better than a beta blocker?

For blacks and older people, calcium channel blockers might work better than other blood pressure medications, such as beta blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers.

Q: Do calcium channel blockers have less side effects than beta blockers?

No significant adverse reactions were observed in either class of the medicines. Conclusion: The study showed the efficacy of Calcium Channel Blocker, Beta Blocker and Angiotensin Receptor Blocker in reduction of SBP & DBP was same, while Calcium Channel Blockers were superior to other two medications.

Q: When do you use calcium channel blockers and beta blockers?

Calcium channel blockers should be favored over beta blockers in patients with asthma (or other forms of pulmonary disease with a bronchospastic component) given the risk of exacerbating bronchospasm.

Q: Which is the reason why a person is prescribed calcium channel blockers?

Calcium channel blockers main uses are to treat heart and circulatory conditions. In the United States, theyve been previously approved to treat the following: High blood pressure (hypertension). Arrhythmias (irregular heartbeat rhythms).

The objective of this study was to determine which of the common groups of antihypertensive drugs is most effective at lowering systolic blood pressure (SBP) in elderly patients with previously untreated hypertension and the percentage of patients controlled with single or sequential monotherapy. Subjects were recruited from patients attending other outpatient clinics and entered into the study if their SBP was more than 150 mm Hg after three visits. Patients were given a low and high dose of each of the main classes of drugs or placebo for 1 month each. The study was a balanced, randomized crossover design with five periods: placebo; angiotensin converting enzyme inhibitors; β-blocking drugs; calcium-blocking drugs; and thiazide diuretics. Blood pressure (BP) was measured 24 to 26 h after the previous dose. A questionnaire for side effects was administered at each visit. Seventy-four patients entered the study. β-Blockers could not be used in 15 patients because of asthma or bronchospasm and these had two placebo periods. There were 9 of 66 patients on P, 9 of 46 on β-blockers, 4 of 65 on calcium-blocking drugs, 4 of 65 on diuretic, and 1 of 62 patients on ACE inhibitors who did not progress to the higher dose because of side effects. Decreases in SBP compared to randomized placebo were calcium-blocking drugs 15 mm Hg = diuretic 13 mm Hg > ACE inhibitors 8 mm Hg = β-blockers 5 mm Hg. Blood pressure decrease correlated with placebo BP (P < .0005, r = 0.53 to 0.70). When corrected for placebo, target SBP (<140 mm Hg) was reached in between 6% to 15% of patients on monotherapy. Sequential monotherapy achieved target in 29%. Angiotensin converting enzyme inhibitors, calcium-blocking drugs, and diuretics had no more side effects than placebo. Patients on β-blockers had more side effects and the well-being score was reduced. Diuretics and calcium-blocking drugs are more effective in elderly patients at lowering SBP pressure. β-Blockers were relatively ineffective, were frequently contraindicated, and had more side effects. Monotherapy achieved control in only a small number of patients. In elderly people with essential hypertension, therapy should be instituted with diuretics or calcium-blocking drugs, but combination therapy will usually be required to achieve goal. Am J Hypertens 2001;14:241–247 © 2001 American Journal of Hypertension, Ltd.

Table of Contents Show

Analysis of data
Effect of low and high dose
Comparison of the effect of the different drugs
Side effects
Biochemical effects
Is a calcium channel blocker better than a beta blocker?
Do calcium channel blockers have less side effects than beta blockers?
When do you use calcium channel blockers and beta blockers?
Which is the reason why a person is prescribed calcium channel blockers?

High blood pressure (BP), which has an adverse effect on prognosis, becomes increasingly frequent as the population ages.1 Systolic blood pressure (SBP), in particular, increases, whereas diastolic blood pressure (DBP) may stay the same or even decrease. This elevation of SBP is more predictive of morbidity and mortality than the DBP.2 The Systolic Hypertension in the Elderly Program (SHEP) study3 has demonstrated that treatment of isolated systolic hypertension with a regime based on a diuretic drug has reduced the number of cerebrovascular and coronary artery events. The Medical Research Council (MRC) study4 and the Swedish Trial in Old Patients with Hypertension (STOP) study5, both in elderly patients, have shown that there was an improvement in mortality from stroke, myocardial infarction, and sudden death when using a diuretic regime that contained a potassium-sparing diuretic. In these two studies diuretics appeared to be more effective than β-blockers to lower BP and in the MRC study β-blockers were relatively poorly tolerated. In the first MRC study6 and in the elderly MRC study4 diuretics were compared with β-blockers and with placebo related to mortality outcome. Diuretics unequivocally improved mortality in both studies, whereas the effect of β-blockers was equivocal in the first study and no better than placebo in the MRC elderly study.

Recently, dihydropyridine calcium channel-blocking drugs7 have been demonstrated to improve the prognosis in elderly patients with systolic hypertension and studies8,9 are underway to determine whether angiotensin converting enzyme (ACE) inhibitors have a similar effect of improving outcome in hypertension and after stroke. Overall, it would appear, particularly related to stroke outcome, that lowering of BP is the critical variable and that improvement occurs no matter what drug is used. The situation may be different related to the outcome from myocardial infarction and sudden death, where the expected improvement in outcome has not been achieved in clinical trials.10

This study was undertaken to determine which drug class lowered BP most effectively in subjects with elevated SBP who had not been previously treated for hypertension. In addition, the study was designed to determine whether the response to one drug class determined the response to other classes of drugs and to determine what percentage of people reached goal on monotherapy.

Methods

The patients were male and female subjects aged 65 to 86 years who were recruited from patients and their relatives attending the outpatient department of the Austin & Repatriation Medical Centre. Volunteer screening booths were established associated particularly with the dermatology, ophthalmology, peripheral vascular disease, general surgery, and urology outpatient services. If the SBP was more than 160 mm Hg at this screening visit subjects were asked to attend the hypertension clinic. At the hypertension clinic patients were seen on at least three separate visits before being randomized to the study. At each visit the patients were weighed and BP was measured in quadruplicate using a Dinamap sphygmomanometer after the patient had been supine for 10 min. The first reading was discarded. At the first visit a history was taken and blood taken for biochemistry. During the run-in period two 24-h urine collections were taken. If the SBP during any run-in visit was less than 140 mm Hg, patients were excluded from further participation. Patients with a history in the past 6 months of myocardial infarction, angina, cerebrovascular accident (stroke or transient ischemic attack), or a severe medical illness likely to reduce their life span to less than 3 years were excluded from the study. Patients were also excluded if their plasma creatinine was more than 0.16 mmol/L or if their liver enzymes were more than three times the normal value. A careful history was taken for a previous history of asthma or the presence of obstructive lung disease. If there was a positive history of asthma or presence of bronchospasm, patients were entered into the study but had an extra placebo period rather than receiving a β-blocking drug.

Patients were randomized to the study if the Dinamap reading at the last run-in visit was more than 150 mm Hg systolic. They were allocated in a balanced randomized crossover design to receive ACE inhibitors, β-blocking drugs, dihydropyridine calcium channel-blocking drugs, thiazide diuretics, or placebo. The ACE inhibitors used were enalapril (n = 24; 20 increasing to 40 mg), perindopril (n = 38; 4 increasing to 8 mg). The calcium-blocking drugs were felodipine (n = 26) and amlodipine (n = 39; 5 increasing to 10 mg). The β-blocking drug was atenolol (25 to 50 mg) and the diuretic was hydrochlorothiazide (25 to 50 mg). The patients received each therapy in a low dose for 1 month and the drug was force titrated in all patients to the higher dose for 1 month unless there were complications related to adverse effects or a BP regarded as excessively low (SBP <110 mm Hg). Having completed one drug arm they then crossed over to the succeeding arm. There were 10 treatment periods of which 8 were active and 2 placebo (Table 1).

Table 1

Systolic and diastolic blood pressure (mm Hg) on the high and low dose of each drug

. Low Dose . High Dose . . n . BP . SEM . n . BP . SEM . Placebo Sys 66 163.5 2.5 57 162.8 2.6 Diast 66 86.8 1.4 57 87.4 1.7 ACE inhibitors Sys 62 153.7 2.0 61 156.5 2.2 Diast 62 85.8 1.5 61 84.5 1.4 β-blockers Sys 46 158.9 3.2 37 158.4 3.4 Diast 46 86.9 1.8 37 83.5 1.5 Calcium blockers Sys 65 154.5 2.1 61 147.4* 1.8 Diast 65 83.6 1.4 61 81.1 1.6 Diuretics Sys 65 151.6 2.0 61 149.1 2.3 Diast 65 83.2 1.4 61 83.0 1.3

Table 1

Systolic and diastolic blood pressure (mm Hg) on the high and low dose of each drug

At the last run-in visit after the Dinamap recording and at each subsequent study visit the patients had an A & D ambulatory monitor (Takeda, Japan) fitted and the BP was taken at 5-min intervals for 1 h with a total of 10 or 12 recordings being obtained. The mean of these values was taken as the BP on that drug. The BP was measured 24 to 26 h after the previous dose. At each visit the patient was weighed and blood taken for biochemistry. The patients were asked to volunteer whether they had any side effects and later during the visit a questionnaire of side effects was administered orally. The starting point for the questionnaire and its sequence was randomized. The patients were also asked to mark how they felt on an analog scale of 1 to 6 (1 worse, 6 best).

If patients had a history of airways disease, asthma, or bronchospasm they could still be randomized to the study but their β-blocking drug period was replaced with a second placebo period. Patients with a history of gout not on treatment were also not allocated to the diuretic group. Patients receiving any of the drug classes associated with treatment of concomitant disease (eg, angina, heart failure) were not included in the study. Patients on corticosteroid therapy were excluded from the study as the dose was likely to alter over this time period. People with unstable disease predicted to require marked alterations in medication were not included.

Analysis of data

To meet the criteria for inclusion in the final analysis of efficacy all patients had to complete the low-dose placebo, and at least two other low-dose periods. The effect of low dose versus high dose of each drug was compared in the patients who completed both periods. For the comparison between the different drug classes on the high dose the value for the low dose was carried forward if a person did not complete the high dose period. The primary analysis was the SBP achieved with the higher dose of each drug compared with placebo and with each other.

The data presented in Tables 1,2,3 through 4 are for the 58 patients who completed treatment on placebo, ACE inhibitors, calcium-blockers, and diuretics. The data for comparison with β-blockers are for the 44 patients who completed all therapies. P values with Bonferroni correction are presented. ANOVA was performed, which confirmed the results. Linear correlations between responses were made.

Table 3

Side effects by questionnaire (% of patients) and percentage of patients who did not progress to the higher dose (%)

. Placebo . ACE Inhibitors . β-Blockers . Calcium Blockers . Diuretics . No. of patients 66 62 46 65 65 Headache 15 (3) 9 11 13 17 (1.5) Faintness 6 4 4 3 6 Lethargy 20 (6) 15 (1.6) 22 (6.5) 17 (1.6) 17 Flushing 4 3 1 2 3 Cough 18 18 11 12 15 Wheeze 12 6 4 8 7 Breathlessness 18 16 13 (4) 13 16 Sexual dysfunction 3 4 4 1 3 Itch 13 8 4 10 8 Cramps 18 (4) 12 14 14 15 Ankle swelling 5 2 2 L3 (1.5) 2 H13 Nausea 5 4 6 (2) L3 (1.5) H11 L5 H12 Sleep disturbance 24 22 19 23 26 (3) Skin rash 4 (4) 1.5 (1.5) Hypotension* 2 (2) 1.5 (1.5) Total side effects† 2.37 2.00 3.56 2.08 2.15

Table 3

Side effects by questionnaire (% of patients) and percentage of patients who did not progress to the higher dose (%)

Table 2

Systolic and diastolic blood pressure and pulse rate achieved with each class of drug

. n . Sys BP (mm/Hg) . Diast BP (mm/Hg) . Pulse (beats/min) . Placebo 58 164.4 ± 2.4 87.8 ± 1.4 66.2 ± 1.4 ACE inhibitors 58 156.5 ± 2.2 (.005) 84.5 ± 1.4 (.01) 68.2 ± 1.4 (.17) β-blockers 44 157.1 ± 2.7 (.3; .03) 83.8 ± 1.4 (.01; .001) 58.4 ± 1.7 (<.0005) Calcium blockers 58 148.4 ± 1.7 (.0005) 81.6 ± 1.6 (<.0005) 67.2 ± 1.4 (.23) Diuretic 58 150.1 ± 2.4 (.0005) 83.6 ± 1.3 (.006) 67.7 ± 1.5 (.7)

Table 2

Systolic and diastolic blood pressure and pulse rate achieved with each class of drug

Table 4

Effect of the different drugs on variables that might alter with the various drugs

. Placebo . ACE Inhibitors . β-Blockers . Calcium Blockers . Diuretic . SEM . n 63 61 46 63 64 Na+ (mmol/L) 141 141 141 141 140 0.4 K+ (mmol/L) 4.58 4.62 4.56 4.44 4.10* 0.05 Creatinine (mmol/L) 0.106 0.109 0.112 0.107 0.110 0.003 Urea (mmol/L) 6.63 7.18 7.34 7.00 8.03* 0.36 Uric acid (mmol/L) 0.40 0.40 0.40 0.39 0.47* 0.014 Cholesterol (mmol/L) 5.59 5.65 5.52 5.58 5.73 0.14 Trig (mmol/L) 1.7 1.84 2.28 (0.22)*,† 1.80 2.00 0.15 HDL (mmol/L) 1.42 1.46 1.28* 1.47 1.47 0.06

Table 4

Effect of the different drugs on variables that might alter with the various drugs

Results

One hundred eighty patients entered the run-in period and 74 were randomized. The patients were 56 men and 18 women with a mean age of 77.3 years (range, 65 to 86 years). Their average weight was 75.6 kg (range, 46 to 107 kg), height 165 cm (range, 152 to 188 cm), and a body mass index of 27.7 (range, 17 to 33). The first comparison was made of the effect of felodipine compared with amlodipine and of perindopril compared with enalapril. There was no significant difference in the BP response achieved and therefore, in subsequent analysis the patients who received amlodipine or felodipine were pooled as were the patients who received enalapril or perindopril.

Seventy-four patients entered the study; 44 patients completed the placebo and all four drug periods; and 58 patients completed placebo and the three drug periods excluding β-blocking drugs. The data are present mainly for this group of 58 patients, but when correlations were made it was between subjects who had completed both groups. For side effects and biochemistry, all patients who received that particular therapy were included.

Fifteen patients had a previous history of asthma or bronchospasm, which meant that β-blocking drugs were contraindicated and accordingly had two placebo periods. One patient had a contraindication to a diuretic. No patient had contraindication to ACE inhibitors or to calcium channel-blocking drugs. A number of patients did not progress to the higher dose of the drug (Table 1). The failure to progress to the higher drug dose was infrequently due to excessive hypotensive effects and was usually attributable to feeling unwell, tired, lethargic, and weak, or the presence of headaches. Most people on ACE inhibitors, calcium-blocking drugs, or diuretics progressed to the higher dose, whereas a significant number of patients on placebo (14%) or β-blockers (20%) failed to progress.

Effect of low and high dose

In the group on placebo the BP on the high and low dose of the drug did not differ for SBP or DBP (Table 1). In this group of elderly patients SBP and DBP were not significantly improved by increasing the drug dose in those on ACE inhibitors or β-blocking drugs. There was a lower SBP (P = not significant) with the higher dose of diuretics. The only drug class to demonstrate a dose-dependent increase in response was the calcium channel-blocking drugs and this was observed with both felodipine and amlodipine.

Comparison of the effect of the different drugs

The data presented are for the response to the higher dose of the drug with a carrying forward of the low drug data if a high dose was not given. These data are after 2 months of therapy on that drug class and were used to minimize any potential carry over effect. The fact that the BP on low and high dose of placebo was similar suggests that any carry over effect is minimal, but the power to detect such an effect was small.

Systolic blood pressure with all classes of drugs was lower than with placebo, but the difference between the SBP on β-blocking drugs and placebo was not significant when the Bonferroni correction was applied (Table 2). β-Blocking drugs were used in a lesser number of patients but this lack of numbers is unlikely to explain the results because the responses to the other drugs in this cohort of patients (n = 44) were significant.

Diastolic blood pressure decreased between 3.6 and 6.7 mm Hg, being much less than the decrease in SBP (Table 2). Pulse rate decreased by 6.6 beats/min (P < .001) in the patients receiving a β-blocking drug. There were small increases in pulse rate with the other drugs (ACE inhibitor, 1.8 beats/min; calcium-blocking drugs, 0.9 beats/min; diuretic, 1.5 beats/min), but none of these were significant.

The decrease in SBP with ACE inhibitors and β-blocking drugs was less than the decrease achieved with the other two drug classes (Fig. 1). There was no difference in the responses to ACE inhibitors and β-blocking drugs and the decrease achieved with diuretics and calcium-blocking drugs did not differ (Fig. 1). There were no significant differences between the decrease in DBP among any of the drug classes.

Decrease in systolic blood pressure (SBP) compared with placebo on the higher dose of each drug. ΔSBP = change in SBP; NS = P value not significant; ACE I = angiotensin converting enzyme inhibitor; β B = β-blocker; Ca++B = calcium blocker; Diur = diuretic.

Nine of 44 patients responded with a decrease of 5 mm Hg or more to all four drugs used. In the group of 58 patients, 21 responded to the three drugs used (β-blocking drugs excluded). Eight of 44 patients did not respond to any of the four drugs. In the group of 58 patients, 9 failed to respond to any of the drugs used. Thus, it appeared that between 21% and 35% of patients were universal responders and between 16% and 18% were universal nonresponders. We accept that the response may have been greater with one or another drug.

The number of patients who achieved the target SBP of less than 140 mm Hg were placebo = 12%, ACE inhibitor = 18%, β-blockers = 17%, calcium-blocking drugs = 27%, and diuretics = 23%. Therefore, the goal of SBP of less than 140 mm Hg was relatively infrequently achieved with monotherapy. Even sequential monotherapy only controlled BP in 29% when corrected for the placebo effect (41% to 12%).

An attempt was made to determine whether the response to one drug class determined the response to other drug classes. When a person responded to one of the two drugs and not to the other, the drug they failed to respond to was usually the β-blocking drug. If a person did not respond to a diuretic or a calcium channel-blocking drug they were unlikely to respond to a β-blocking drug. However, the converse was not true and many people who did not respond to a β-blocking drug responded to a diuretic, a calcium channel-blocking drug, or an ACE inhibitor. People who did not respond to an ACE inhibitor were more likely to respond to a calcium-blocking drug than to a diuretic or a β-blocking drug.

The responses in SBP between each two drugs were also compared by linear regression analysis. The correlation coefficients were all highly significant (P < .005) and the r values were between 0.45 and 0.60. The highest r value was the comparison between diuretics and calcium-blockers (r = 0.60) and the next highest was between β-blockers and ACE inhibitors (r = 0.57). The decrease in BP with all drugs used correlated significantly (P < .0005) with the placebo BP with r values between 0.53 and 0.70 (ACE inhibitor = 0.53; β-blockers = 0.56; calcium-blocking drugs = 0.70; diuretic = 0.54).

Well-being

The patient's sense of well-being was assessed by an analog score of 1 to 6. The mean scores for placebo, ACE inhibitors, calcium-blockers, and diuretics were similar (4.35 to 4.40). β-Blockers score was lower than the rest (4.00). The least percentage of people with a score of 6 (excellent) were on β-blocking drugs (6%) or placebo (9%) and these two groups had the greatest percentage of people with a score of 1 (worst).

Side effects

The side effects were graded on a scale of 1 to 4 (1 being trivial to 4 causing inconvenience). The questionnaire side effects are indicated in Table 3. Most side effects were less common or not different on drug therapy compared to placebo, apart from ankle swelling being more common on the higher dose of calcium-blocking drugs and nausea being more common on the higher doses of diuretics and calcium-blocking drugs. Cough was not more prevalent on ACE inhibitors, but if we related it to severity it became more common.

Side effects did prevent some patients from progressing to the higher dose of the drug (Tables 1 and 3). This was most common in people on β-blocking drugs (20%; 9 of 44) and was more common on placebo than with the other three drug classes. When it is recognized that 15 of 74 patients were ineligible to receive β-blockers because of respiratory disease this meant that β-blockers could not be used in about 30% of patients in this age group selected by this method.

Biochemical effects

The effects of the different drugs on mean values of selected biochemical variables are indicated in Table 4. Medication was not stopped in any patient because of excessive alterations in these variables. β-Blocking drugs increased triglycerides and reduced HDL (P < .03) in a nondose-related manner. Diuretics increased urea, uric acid, and reduced potassium levels (P < .01) in a dose-dependent manner (P < .01).

Discussion

This study confirms and extends results of other studies,4,5,11,12 but it is important to emphasize that this study compares decrease in BP, efficacy, and tolerability, and provides no information on outcome. β-Blocking drugs are relatively inefficient at lowering BP in elderly persons with elevated SBP. This is similar to what was observed in the STOP study. On monotherapy, only 10% to 12% of patients on β-blockers had reached BP control compared to 30% on diuretics.11 Likewise in the MRC study5 in the elderly the BP decrease with β-blocking drugs was less than with diuretics and only 50% of individuals maintained that therapy at the end of the study. In our study β-blocking drugs were believed to be contraindicated in about 30% of patients due to airway disease. This may be higher than in the general population because of our method of recruitment. Despite excluding 20% from β-blocking therapy we also had 20% of patients who did not progress to the higher dose due to side effects. When this poor tolerance to β-blocking drugs and the poor effect on lowering SBP is coupled with their relative ineffectiveness at improving prognosis in the two MRC studies,4,6 it is hard to justify the use of β-blocking drugs as first-line therapy in elderly hypertensive patients unless there is a positive indicator such as angina and possibly tachycardia. The adverse change in the lipid profile is a further reason why these drugs should be avoided.

The drugs that were most effective at lowering BP were diuretics and calcium channel-blocking drugs and both groups were well tolerated. In a study by Materson et al,12 done as a parallel design, calcium-blocking drugs in the overall study population were most effective. In the older age group of patients SBP when corrected for placebo response decreased by calcium-blockers by 12 mm Hg, diuretics by 13 mm Hg, β-blockers by 7 mm Hg, and ACE inhibitors by 7 mm Hg. These decreases are similar to what we have demonstrated. Likewise Freis13 demonstrated that diuretics were more effective than β-blocking drugs or ACE inhibitors in elderly patients. It is proposed that the lower renin level in the elderly and black populations make these groups of patients more resistant to ACE inhibitors and β-blocking drugs. The poor response to β-blocking drugs and ACE inhibitors is supported by this study, although we were unable to demonstrate a correlation with the initial plasma renin level or 24-h urine sodium concentration (data not shown). Diuretics4,5 and calcium-blocking drugs7 have both been demonstrated to improve mortality in elderly people with systolic hypertension and they are our drugs of first choice. However, it must be recognized that the three individual studies4,5,14 that showed an improvement in mortality from cardiac disease all used a potassium-sparing diuretic in addition to a thiazide and sudden death was reduced. The recent results of the RALES15 study infer that we should use diuretics cautiously, particularly if moderate to high doses are used, and we should consider the use of a potassium-sparing agent by itself or in combination as first-line therapy.

Angiotensin converting enzyme inhibitors were not as effective as calcium-blocking drugs or diuretics in this study of previously untreated patients with systolic hypertension and on the typical sodium chloride intake. The drug effectiveness may have been improved if patients were on a reduced sodium chloride intake.16 The ACE inhibitors were, however, well tolerated. This result does not infer that ACE inhibitors should not be used, but that they are probably not the drug of first choice in elderly hypertensive patients. The relatively poor response appears at variance with the response rate quoted in recent studies of ACE inhibitors and of angiotensin-I receptor-blocking drugs.17,18 However, these studies are frequently conducted in previously treated hypertensive patients and these patients are almost certainly recruited from people who are known to respond. It must be remembered that in the elderly, cardiac failure is becoming increasingly frequent and a significant amount of this is attributable to diastolic dysfunction subsequent to high BP. It is possible that the benefit of blockading the angiotensin system may be greater than the BP lowering effect and the studies to prove this are awaited.8

In our study monotherapy was relatively ineffective at obtaining the goal. In the study by Materson et al12 on patients of all ages it is stated that monotherapy was effective. However, when corrected for the number of patients in the placebo group who reached the goal, the percentages were calcium-blockers, 34%; β-blockers, 26%; diuretics, 21%; and ACE inhibitors, 17%, results relatively similar to our findings. In the older age group, calcium-blockers and diuretics were more effective than β-blockers, but relatively few reached the goal. In our study even if sequential monotherapy was conducted, 71% of patients did not reach the lower BP goal. The response rate to monotherapy when corrected for placebo was disappointing and giving higher doses of drugs of the same class was relatively ineffectual. It is possible that low-dose combination therapy may achieve a better response. Some possible combinations with a good theoretical or proved basis in the elderly are diuretics and ACE inhibitors,19 ACE inhibitors and calcium-blocking drugs,20 and diuretics and β-blocking drugs. Most of the studies that have shown the best improvement in outcome have used combination therapy to obtain good control and good prognostic results,3,5,21,22 whereas studies using predominantly monotherapy have not been as effective for BP control or prognosis.4,6

The study did not have sufficient power to evaluate properly the cross-prediction between the drugs. There appeared to be a group who responded to all drugs and another group who responded to none. There were correlations between response but no clear guidelines could be derived for the drug to use in a nonresponder.

Mortality outcome studies are important to allow decision making in the management of hypertension. However, tolerability, effectiveness, and cost of the medication and its delivery are other important criteria that influence the decision. The results of this study together with outcome studies infer that in elderly patients with essential hypertension it is appropriate to start therapy with a calcium channel-blocking drug or a diuretic at a low dose and if control is not achieved it is probably sensible to proceed to low dose dual therapy.

The nursing support of Maree Mastwyk, Jan Lauri, Anne Bruce, Denise Bertram, and Olive Morgan is appreciated.

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Is a calcium channel blocker better than a beta blocker?

For blacks and older people, calcium channel blockers might work better than other blood pressure medications, such as beta blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers.

Do calcium channel blockers have less side effects than beta blockers?

No significant adverse reactions were observed in either class of the medicines. Conclusion: The study showed the efficacy of Calcium Channel Blocker, Beta Blocker and Angiotensin Receptor Blocker in reduction of SBP & DBP was same, while Calcium Channel Blockers were superior to other two medications.

When do you use calcium channel blockers and beta blockers?

Calcium channel blockers should be favored over beta blockers in patients with asthma (or other forms of pulmonary disease with a bronchospastic component) given the risk of exacerbating bronchospasm.

Which is the reason why a person is prescribed calcium channel blockers?

Calcium channel blockers' main uses are to treat heart and circulatory conditions. In the United States, they've been previously approved to treat the following: High blood pressure (hypertension). Arrhythmias (irregular heartbeat rhythms).