The Place of the Calcium Antagonist Verapamil in Antihypertensive Therapy

The antihypertensive efficacy of the calcium antagonist verapamil was tested in 43 patients with essential hypertension, examining relationships between age and pretreatment renin and blood pressure and comparing intraindividually the responses with those obtained using β-blockers (n = 29) and diuretic therapy (n = 18). Verapamil produced a decrease in mean blood pressure that was directly related to the patientʼs age and pretreatment blood pressure but inversely to pretreatment renin. Although there was no difference in overall pressure response between verapamil, β-blocker, and diuretic therapy, the pressure responses with diuretics paralleled those obtained with verapamil, whereas, in contrast, responses with β-blockers correlated indirectly with the patientʼs age and directly with pretreatment renin. These data provide the basis for a new antihypertensive treatment concept proposing a calcium antagonist as the first choice for the older and low renin patients in place of a diuretic agent and a β-blocker as the first-line drug for the younger and high renin patients.