Key result
The WHO-ISH statement on calcium antagonists is marred by selective use of evidence, making existing hypertension and post-myocardial infarction guidelines more useful for practicing clinicians.
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The authors argue that the WHO-ISH statement on calcium antagonists is flawed and recommend relying on existing hypertension and post-MI guidelines instead.
The controversy over the efficacy and safety of calcium antagonists is over 2 years old. Since millions of patients worldwide are currently using calcium antagonists for the treatment of high blood pressure and angina, a systematic review of their potential risks and benefits is much needed. In response to this need, the World Health Organization (WHO) and the International Society of Hypertension (ISH) recently convened an ad-hoc subcommittee to review the available evidence (J Hypertens 1997, 15:105-115). Importantly, the WHO-ISH statement does take a strong stand in favor of large long-term trials that compare antihypertensive agents, and we all agree that these comparative trials are urgently needed. However, the WHO-ISH statement is marred in part by errors of omission, by the selective use of evidence and epidemiologic principles, and by a narrow application of the viewpoint of those who believe that evidence can come only from the results of megatrials. As a result, practicing clinicians will find more useful information in existing hypertension and postmyocardial infarction guidelines (Arch Intern Med 1993, 153:154-183 and JAm Coll Cardiol 1996, 28:1328-1428).
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Psaty et al. (1997) conducted an editorial in High blood pressure and angina. Calcium antagonists was evaluated. The WHO-ISH statement on calcium antagonists is marred by selective use of evidence, making existing hypertension and post-myocardial infarction guidelines more useful for practicing clinicians.
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