Health outcomes associated with calcium antagonists compared with other first-line antihypertensive therapies: a meta-analysis of randomised controlled trials

Lancet. 2000 Dec 9;356(9246):1949-54. doi: 10.1016/S0140-6736(00)03306-7.


Background: Several observational studies and individual randomised trials in hypertension have suggested that, compared with other drugs, calcium antagonists may be associated with a higher risk of coronary events, despite similar blood-pressure control. The aim of this meta-analysis was to compare the effects of calcium antagonists and other antihypertensive drugs on major cardiovascular events.

Methods: We undertook a meta-analysis of trials in hypertension that assessed cardiovascular events and included at least 100 patients, who were randomly assigned intermediate-acting or long-acting calcium antagonists or other antihypertensive drugs and who were followed up for at least 2 years.

Findings: The nine eligible trials included 27,743 participants. Calcium antagonists and other drugs achieved similar control of both systolic and diastolic blood pressure. Compared with patients assigned diuretics, beta-blockers, angiotensin-converting-enzyme inhibitors, or clonidine (n=15,044), those assigned calcium antagonists (n=12,699) had a significantly higher risk of acute myocardial infarction (odds ratio 1.26 [95% CI 1.11-1.43], p=0.0003), congestive heart failure (1.25 [1.07-1.46], p=0.005), and major cardiovascular events (1.10 [1.02-1.18], p=0.018). The treatment differences were within the play of chance for the outcomes of stroke (0.90 [0.80-1.02], p=0.10) and all-cause mortality (1.03 [0.94-1.13], p=0.54).

Interpretation: In randomised controlled trials, the large available database suggests that calcium antagonists are inferior to other types of antihypertensive drugs as first-line agents in reducing the risks of several major complications of hypertension. On the basis of these data, the longer-acting calcium antagonists cannot be recommended as first-line therapy for hypertension.

Publication types

  • Comparative Study
  • Meta-Analysis

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / drug effects
  • Calcium Channel Blockers / therapeutic use*
  • Coronary Disease / prevention & control
  • Diastole
  • Female
  • Heart Failure / prevention & control
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / mortality
  • Male
  • Middle Aged
  • Myocardial Infarction / prevention & control
  • Randomized Controlled Trials as Topic
  • Stroke / prevention & control
  • Systole
  • Treatment Outcome


  • Antihypertensive Agents
  • Calcium Channel Blockers