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| |  ESC: Beta Blockers May Attenuate Mortality in Black Patients Taking Certain Calcium Channel Blockers By Bruce Wilson Special to DG News BERLIN, GERMANY -- September 13, 2002 -- Adding a beta blocker to a short-acting calcium channel blocker may significantly reduce the likelihood of mortality in African-American patients with hypertension, say researchers from Washington, DC. Calcium channel blockers are widely used in African-Americans for the treatment of hypertension and coronary heart disease because of their potent antihypertensive effects. However, studies in mostly Caucasian patients have shown short-acting formulations have adverse effects on cardiovascular outcomes, an effect not clearly defined in African-Americans. Dr. Andreas E. Pittaras, from the Veterans Affairs and Georgetown University Medical Centres, in Washington, DC, and colleagues studied the effect of treatment on mortality rates in 812 African-American men, mean age 68 years, who were undergoing a cardiac workup. Of these patients, 309 were treated with a calcium channel blocker (CCB), 87 with a beta blocker (BB), 151 with both and 265 were on neither. Among patients treated with a CCB, 141 were on nifedipine, 234 on diltiazem, 38 on verapamil, 41 on amlodipine and eight on felodipine. Workup included diagnostic cardiac catheterisation, echocardiogram, Holter electrocardiographic monitoring, exercise treadmill test and blood chemistry. Patients treated with CCB had more favourable ejection fraction compared to the other treatment groups (58±16 vs. 54±17; p<0.001), Dr. Pittaris reported. A total 286 deaths occurred during the ten-year follow-up. Mortality rates were higher in patients receiving CCBs (p=0.000), however, when CCB treatment was combined with BB, the risk was lower than CCB alone (p=0.0001). Subgroup analysis revealed that most of the increased mortality was due to short-acting nifedipine (58 percent vs. 23 percent;OR:4.4; p<0.000), which at the time of the study, was the only formulation of nifedipine available. When nifedipine was combined with a BB, the risk was lower than nifedipine alone (p=0.001). Dr. Pittaris reported that the mortality effect with diltiazem, verapamil and felodipine was similar to placebo, however, the combination of diltiazem and a BB had a lower risk than diltiazem alone (p=0.03). Amlodipine actually had a favourable effect in mortality rates (4.8 percent vs. 30 percent), he noted. Co-authors of the study were from Mediton Medical Center, in Athens, Greece, and VA and the Georgetown University Medical Centres, in Washington, DC, United States.
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