Nilvadipine, a calcium antagonist of the dihydropyridine class, selectively blocks calcium channels in vascular smooth muscle. Compared with nifedipine, the prototype of the dihydropyridines, nilvadipine has a longer duration of action. The antihypertensive efficacy of nilvadipine appears to be comparable with that of nicardipine and nitrendipine, enalapril and captopril and hydrochlorothiazide/triamterene, although further clinical experience is required to establish the claimed advantages nilvadipine may have over the other dihydropyridine derivatives currently used to treat hypertension. Preliminary studies suggest that nilvadipine may also be useful in the treatment of patients with stable exertional or variant angina. Studies conducted in Japan indicate that nilvadipine improves symptoms resulting from cerebral infarction in some patients, but further comparative studies are required to confirm these results. The tolerability of nilvadipine appears to be comparable with that of nicardipine and better than that of nifedipine with respect to flushes, oedema and liver function abnormalities. As is typical of calcium antagonists, there is no evidence of tolerance to the antihypertensive effects of nilvadipine. The drug is equally effective in treating hypertension in elderly and younger patients and does not appear to adversely affect glucose or lipid metabolism. Thus, provided its apparently good tolerability is confirmed by wider clinical experience, it should be a suitable alternative to other calcium antagonists when used alone or in conjunction with other drugs for the majority of patients with mild to moderate hypertension.