Effects of antihypertensive therapy on cardiac function

The failure of clinical trials in the treatment of hypertension to show protection against mortality from coronary heart disease has prompted a major reconsideration of the indications and modes of therapy. One area of concern is the lipid disturbances seen with diuretics and non-ISA (intrinsic sympathomimetic activity) beta blockers; another is the negative inotropic effect of beta blockers. The more widespread use of vasodilators-either alpha-blockers, angiotensin-converting enzyme (ACE) inhibitors, or calcium channel blockers-therefore seems appropriate. Among the calcium channel blockers, nicardipine appears to be a particularly attractive choice, in part because of its lack of negative inotropism.