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Secondary Prevention With Calcium Antagonists After a Myocardial Infarction-Reply

Prakash C. Deedwania, MD; Enrique V. Carbajal, MD
Arch Intern Med. 1993;153(19):2281-2287. doi:10.1001/archinte.1993.00410190123016.
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We agree with the comment of Hansen that the findings of the Secondary Prevention Reinfarction Israel Nifedipine Trial1 clearly emphasize the importance of differences in the actions of various calcium-channel blockers. As stated by Hansen, the results of the Second Danish Verapamil Infarction Trial II2 were in clear contrast with the findings reported by the Israel trial investigators. Although early administration of nifedipine in survivors of acute myocardial infarction (in the Danish trial) was associated with increased mortality in the postinfarction period, the results of the Danish trial demonstrated a beneficial effect of verapamil in reducing the risk of reinfarction in the postinfarction period. Although there were some differences in the clinical features and the initiation of therapy with the specific calcium-channel blocker in the two studies, it is unlikely that these differences account for the contrasting results. As described previously,3 the most likely explanation for the


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