Since the earlier review in Drugs substantial additional data have accumulated 
regarding the antihypertensive efficacy of isradipine in various clinical 
situations, as well as data on its clinical effects in atherosclerosis. Recent 
therapeutic trials confirm that the efficacy of isradipine in the treatment of 
patients with mainly mild to moderate hypertension, when administered orally as 
a conventional or modified release preparation, is similar to that of titrated 
dosages of amlodipine, felodipine, nifedipine, diltiazem, captopril, methyldopa, 
metoprolol, prazosin and hydrochlorothiazide. A further decrease in blood 
pressure can be expected when isradipine is combined with another 
antihypertensive drug in patients who have not responded adequately to 
monotherapy. Initial studies have shown that intravenous isradipine is effective 
in controlling hypertension following coronary artery bypass graft surgery and 
that it appears useful in the treatment of intraoperative hypertension and 
hypertensive crisis, and in hypertensive disorders in pregnancy, when 
administered orally or intravenously. A large study, the Multicentre Isradipine 
Diuretic Atherosclerosis Study (MIDAS), was designed to compare the efficacy of 
isradipine and hydrochlorothiazide in reducing the rate of progression of 
carotid artery wall thickness, measured by B-mode ultrasound, as a surrogate for 
early atherosclerosis. Results indicated that wall thickness increased 
significantly less with isradipine than hydrochlorothiazide after 6 months of 
therapy. Thereafter the rate of progression remained parallel for the remainder 
of the 3-year trial. The confirmation of its antihypertensive efficacy, along 
with its favourable haemodynamic profile and reversal of left ventricular 
hypertrophy, minimal effect on glucose and lipid metabolism, preservation of 
quality of life and good tolerability, makes isradipine a suitable drug for the 
treatment of most patients with mild to moderate hypertension.