Comparative Efficacy of Amlodipine and Lercanidipine in the Prevention of Major Adverse Cardiovascular Events in Hypertensive Patients

Objective: Amlodipine is the most widely prescribed calcium channel blocker (CCB) for hypertension. Lercanidipine, a newer CCB, is reported to exhibit fewer side effects, such as peripheral edema, and is believed to have beneficial effects on myocardial ischemia and congestive heart failure. However, its impact on major adverse cardiovascular events (MACE) has not been comprehensively explored. This study aims to elucidate the clinical efficacy of Lercanidipine in the prevention of major adverse cardiovascular events to that of Amlodipine. Design and method: A retrospective cohort study was conducted by analyzing electronic health records from three tertiary hospitals in Korea. We identified patients who were administered Lercanidipine (n = 2,182) or Amlodipine (n = 45,458) for a minimum of 30 days from January 1, 2017, to November 30, 2021. The incidence of MACE, including cardiovascular death, myocardial infarction, stroke, heart failure hospitalization, and coronary revascularization, was assessed over a three-year follow-up period. A total of 4,680 Amlodipine and 1,570 Lercanidipine patients were evaluated, with propensity score matching at a ratio of 1:3 after excluding those with end-stage renal disease. Results: Patients in the Lercanidipine cohort had a higher prevalence of low socioeconomic status, diabetes, hyperlipidemia, and chronic kidney disease. The usage of more than three antihypertensive drugs was more common in this group. The cardiovascular risk estimated by SCORE2/SCORE2-OP was also higher in the Lercanidipine cohort. After the propensity score matching, the incidence of MACE was numerically lower in the Lercanidipine group (2.8%) compared to the Amlodipine group (4.1%), but the difference was not statistically significant (p = 0.11). No differences in blood pressure control were observed over the follow-up period. Conclusions: In patients with higher cardiovascular risk profiles, Lercanidipine was preferred to Amlodipine. The study found that Lercanidipine had comparable efficacy to Amlodipine in preventing cardiovascular events.