caa a22 4500 477072402 CHVBK 20180405111430.0 cr unu---uuuuu 170330e19960901xx s 000 0 eng 10.1007/BF00051111 doi (NATIONALLICENCE)springer-10.1007/BF00051111 Should calcium antagonists be first-line agents in the treatment of cardiovascular disease? The public health perspective [Elektronische Daten] [Curt Furberg, Bruce Psaty] Summary: The calcium antagonist (CA) controversy has been fueled in part by disagreements among scientists and clinicians over the scientific documentation required for drugs used to treat lifelong conditions. From a public health perspective, there are three unanswered questions: (1) Does long-term use of CAs convey health benefits to patients with cardiovascular disease (CVD)? (2) Is the long-term use of CAs safe? (3) Is the use of CAs cost effective? The answers to these questions determine the pertinence of three secondary questions: (4) Do the effects of CAs reflect a class action or are there important differences in health outcomes among subclasses of CAs? (5) Are the short-acting, immediate-release (IR) formulations different from the long-acting or the slow-release (SR) formulations? (6) What is prudent use of CAs? The purpose of this report is to summarize the answers to these questions from a public health perspective. (1) To data, use of CAs has not been documented to reduce the risks of cardiovascular complications of hypertension—stroke, myocardial infarction, congestive heart failure, or renal dysfunction. (2) The clinical trial database is inadequate to determine the long-term safety of CAs. The available data suggest that some formulations of CAs may be associated with an increased risk of cardiovascular and noncardiovascular events. (3) Even if slow-release CAs conveyed a benefit, their cost-effectiveness ratios are unlikely to be acceptable. (4) The non-dihydropyridines may offer an advantage over the dihydropyridines. (5) Whether the slow-release formulations differ from the immediate-release formulations in terms of their health effects remains to be seen. (6) It may be prudent clinically to restrict the use of CAs until proper documentation of long-term safety and efficacy and cost effectiveness is available. Kluwer Academic Publishers, 1996 calcium antagonists nationallicence cost effectiveness nationallicence safety nationallicence efficacy nationallicence public health nationallicence Furberg Curt Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC aut Psaty Bruce Department of Medicine, University of Washington, Seattle, WA aut Cardiovascular Drugs and Therapy Kluwer Academic Publishers 10/4(1996-09-01), 463-466 0920-3206 10:4<463 1996 10 10557 https://doi.org/10.1007/BF00051111 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF00051111 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Furberg Curt Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC aut NATIONALLICENCE 700 1- Psaty Bruce Department of Medicine, University of Washington, Seattle, WA aut NATIONALLICENCE 773 0- Cardiovascular Drugs and Therapy Kluwer Academic Publishers 10/4(1996-09-01), 463-466 0920-3206 10:4<463 1996 10 10557 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer