CARDIAC BENEFITS OF ACE-INHIBITORS AND CALCIUM-ANTAGONISTS ALONE AND IN COMBINATION

No large mortality trials have been completed comparing either angiotensin-converting enzyme (ACE) inhibitors or calcium-entry-blocking drugs with placebo or established drugs in the treatment of hypertension, although these are now about to start. Several large mortality studies in ischemic heart disease or cardiac failure allow us to make some general comments in favor of ACE inhibitors separately, or in favor of some calcium-channel blockers separately. There is no mortality evidence for first-generation dihydropyridines, but rather the reverse. There is good evidence in favor of verapamil and diltiazem, perhaps because of their lack of peripheral vasodilatation and reflex tachycardia. No large studies have been carried out comparing calcium-channel blockers with ACE inhibitors.