Calcium antagonists and mortality. Another case of the need for clinical judgment

IN RECENTyears, few medical topics have evoked the controversy, emotional response, media attention, and concern among patients equal to that surrounding the question of possibly increased mortality associated with calcium antagonists. In less than 6 months, there have been two metaanalyses involving patients with hypertension 1 and coronary heart disease 2 , four accompanying editorials, 3-6 a statement from the National Heart, Lung, and Blood Institute, 7 and innumerable articles in the lay press. Physicians have been bombarded by calls from concerned and frightened patients, and some patients have stopped their antihypertensive and antianginal therapy without consulting with their physicians. See also pages 2150 and 2157 This question of possibly increased mortality with a class of drugs proven to produce improvement in symptoms and surrogate end points, eg, decreased blood pressure, is a quintessential example of the problems faced by practicing clinicians on a daily basis, ie, making clinical decisions