Calcium Channel Blockers: Key Medicine to Drive Global Hypertension Control

HEARTS protocol including initial CCB more effective than usual care without preferred protocol medicines (5)

Comparable HTN control rate

88% of HEARTS HTN treatment protocols include CCB at Step 1 (either monotherapy or part of dual therapy) (15)

26% of HEARTS HTN treatment protocols recommend maximal dose CCB monotherapy at the second protocol step (15)

Many LMIC PHC facilities lack laboratory testing; CCBs cause no metabolic adverse effects and do not require laboratory testing

The main CCB side effect is pedal edema, which is dose-dependent and reverses with CCB discontinuation

Limited affordability of antihypertensive medicines in many LMICs (16)

As monotherapies, CCBs are among the most available and affordable antihypertensive medicines in LMICs (16)

However, prices of single-pill combinations including CCBs are often not affordable in all LMICs (17)

CCB monotherapies are available for purchase for public and private sector payers in LMICs (16)

Because CCBs can be used to manage HTN in pregnancy, these agents are often more reliably available in PHCs that provide peripartum care

Single-pill combinations including CCBs are not consistently available in LMICs

CCBs are stable across a range of temperatures, and due to no need for laboratory monitoring they can be dispensed by non-physician health workers at the community clinic level, as in the Bangladesh Community-Based HEARTS study

Head-to-head comparisons of HEARTS protocol variations to assess comparative effectiveness and safety of maximal dose CCB monotherapy regimens

Implementation studies are needed to evaluate implementation barriers and facilitators of CCB-containing dual and triple combination therapies