Drug Profile

Do Not Use: This drug can cause low blood pressure, heart attack and stroke.

The short-acting form of nifedipine (ADALAT, PROCARDIA) is approved by the Food and Drug Administration (FDA) only for the treatment of chest pain (angina). It has never been approved to treat any type of high blood pressure, including high blood pressure emergencies. In fact, in 1985, an FDA advisory committee voted unanimously not to recommend that short-acting nifedipine be approved to treat high blood pressure emergencies.[1]  

The National Heart, Lung, and Blood Institute, part of the National Institutes of Health, declared in August 1995 that “short-acting nifedipine should be used with great caution (if at all), especially at higher doses, in the treatment of hypertension, angina, and MI (heart attack).”[2] 

An article appearing in the Journal of the American Medical Association in 1996 called for a moratorium on the use of short-acting nifedipine to treat high blood pressure emergencies. The article states that "A review of the literature revealed reports of serious adverse effects such as cerebrovascular ischemia, stroke, numerous instances of severe hypotension, acute myocardial infarction, conduction disturbances, fetal distress, and death."[3] 

The countless injuries and deaths that occurred when short-acting nifedipine was used to treat chronic high blood pressure or high blood pressure emergencies were preventable tragedies. 

A study was published in the medical journal Neurology examining the use of short- acting nifedipine and the risk of stroke in elderly patients with hypertension. The data evaluated in this study showed that the use of short-acting nifedipine in elderly patients with hypertension may result in an increased risk of stroke. It is recommended that this drug be used with caution in these patients.[4]

First-line treatment for high blood pressure

If you have high blood pressure, the best way to reduce or eliminate your need for medication is by improving your diet, losing weight, exercising and decreasing your salt and alcohol intake. Mild hypertension can be controlled by proper nutrition and exercise. If these measures do not lower your blood pressure enough and you need medication, hydrochlorothiazide (ESIDRIX, HYDRODIURIL, MICROZIDE), a water pill, is the drug of choice, starting with a low dose of 12.5 milligrams daily. It also costs less than other blood-pressure drugs. 

There is growing evidence that thiazide diuretics, such as hydrochlorothiazide, significantly decrease the rate of bone mineral loss in both men and women because they reduce the amount of calcium lost in the urine.[5] Research now suggests that thiazide diuretics may protect against hip fracture.[6] 

If your high blood pressure is more severe, and hydrochlorothiazide alone does not control it, a drug in another family of high-blood-pressure-lowering drugs may be added to your treatment. In this case, your doctor would prescribe the hydrochlorothiazide and the second drug separately, with the dose of each drug adjusted to meet your needs, rather than using a product that combines the drug in a fixed combination. 

Whatever drugs you take for high blood pressure, once your blood pressure has been normal for a year or more, a cautious decrease in dose and renewed attention to nondrug treatment may be worth trying, according to The Medical Letter on Drugs and Therapeutics.[7] 

An editorial in the British Medical Journal stated:

Treatment of hypertension is part of preventive medicine and like all preventive strategies, its progress should be regularly reviewed by whoever initiates it. Many problems could be avoided by not starting antihypertensive treatment until after prolonged observation. ... Patients should no longer be told that treatment is necessarily for life: the possibility of reducing or stopping treatment should be mentioned at the outset.[8]

The May 2012 issue of Worst Pills, Best Pills News highlighted a recent BMJ study indicating that patients taking several types of commonly used antihypertensive medications are at increased risk of developing gout, a type of arthritis.

The BMJ study also showed that a small number of other antihypertensive drugs appear to have the opposite effect, decreasing the risk of gout.

All patients should be informed of the risk of gout with diuretics, beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors) and non-lorsartan angiotensin II receptor blockers (ARBs) when starting these medications or increasing their dosages.[9]