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Journal of Renin-Angiotensin-Aldosterone System
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Review: Calcium channel blockade in combination with angiotensin-converting enzyme inhibition or angiotensin II (AT1-receptor) antagonism in hypertensive diabetics and patients with renal disease and hypertension

Philip Swales

Cardiovascular Research Institute, University of Leicester, Sir Robert Kilpatrick Clinical Sciences Building, PO Box 65, Leicester Royal Infirmary, Leicester, LE2 7LX, UK

Bryan Williams

Cardiovascular Research Institute, University of Leicester, Sir Robert Kilpatrick Clinical Sciences Building, PO Box 65, Leicester Royal Infirmary, Leicester, LE2 7LX, UK, bw17{at}le.ac.uk

Effective reduction in blood pressure (BP) improves survival and morbidity in hypertensive patients. Combination therapy with multiple antihypertensive agents is frequently required in clinical practice and therapeutic trials to achieve target BP. Patients at elevated cardiovascular risk achieve the greatest benefit from equivalent reduction in BP and also require more stringent BP control. In patients with hypertension and diabetes mellitus or renal disease, BP control is of primary importance and blockade of the renin-angiotensin system (RAS) should be the initial therapeutic intervention. Choice of combination therapy has been insufficiently studied in major clinical cardiovascular endpoint trials. Diuretic therapy remains the logical addition to RAS blockade. Despite previous debate, the available evidence suggests long-acting calcium-channel blockers are also a safe and very effective addition to improve BP control further. The choice of antihypertensive combination therapy should not override the fundamental necessity of lowering BP to target levels.

Key Words: hypertension • diabetes mellitus • renal disease • angiotensin-converting enzyme inhibitor • angiotensin II receptor antagonist • calcium channel blockade

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Journal of Renin-Angiotensin-Aldosterone System, Vol. 3, No. 2, 79-89 (2002)
DOI: 10.3317/jraas.2002.022
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