The factors determining the acute and long-term response to calcium antagonists have been studied in controlled trials in essential hypertension. The importance of dose and plasma level in determining the response has been confirmed. The blood pressure response has been modelled and mathematically described, with drug concentrations related to blood pressure falls by linear or Emax (maximum fall in blood pressure) models. The acute response predicted the response after 6 weeks of treatment. Neither age nor plasma renin activity independently influenced the response to calcium antagonists. The level of pretreatment blood pressure (starting blood pressure) was positively related to indices of response. In similar studies with other drugs modifying myogenic tone, while vascular reactivity to selective agonists was reduced, enhanced or unchanged, blood pressure falls were related to plasma levels in all cases.
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