The Secondary Prevention Reinfarction Israel Nifedipine Trial 2 study recently published in the Archives1 demonstrates the importance of testing the value of each calcium-channel blocker for secondary prevention after an acute myocardial infarction and consideration that all calcium-channel blockers are not equal,2 probably contrary to β-blockers.3
In an accompanying editorial, Deedwania and Carbajal4 discuss secondary prevention underlining aspirin and β-blockers as first-time treatment, which is now generally accepted. But, as stated in the editorial, a major problem is that after an acute myocardial infarction only 20% to 30% of the patients were treated with β-blockers. The most likely explanation of this low figure is that contraindications to, or unacceptable side effects of, β-blockers prevent their use in a large number of patients. For this reason, it is important to look for alternatives to β-blockers for secondary prevention.
Deedwania and Carbajal also describe diltiazem as an established