S-amlodipine was associated with a reduced incidence of 3P-MACE compared to racemic amlodipine in patients with hypertension (aHR 0.87; 95% CI 0.81-0.94; P<0.001).
Cohort (n=45,660)
Does S-amlodipine reduce long-term major adverse cardiovascular events compared to racemic amlodipine in patients with hypertension and no prior cardiovascular disease?
In hypertensive patients without prior cardiovascular disease, S-amlodipine was associated with better medication adherence and a lower risk of long-term major adverse cardiovascular events compared to racemic amlodipine.
Effect estimate: aHR 0.87 (95% CI 0.81-0.94)
p-value: p=<0.001
Although S-amlodipine is known to have similar effects in lowering blood pressure and fewer side effects compared to amlodipine (= mixture of S- and R-amlodipine), there are no available data on its impact on long-term cardiovascular prognosis. This retrospective cohort study analyzed claims data from Korean subjects with hypertension treated with either S-amlodipine or amlodipine from 2010 to 2020. Subjects with prior history of cardiovascular disease or stroke were excluded. The composite endpoints of all-cause death, myocardial infarction, and stroke as 3P-major adverse cardiovascular event (MACE) and the composite endpoints of 3P-MACE and heart failure hospitalization as 4P-MACE were assessed. The study included 1:2 propensity score-matched groups of subjects taking S-amlodipine (n = 15,709) and amlodipine (n = 29,951). The mean clinical follow-up duration was 4.9 ± 0.3 years (median 5.0 years). After adjusting for clinical factors, S-amlodipine was associated with a reduced incidence of 3P-MACE (adjusted hazard ratio aHR, 0.87; 95% confidence interval CI, 0.81-0.94; P < 0.001), and 4P-MACE (aHR, 0.86; 95% CI, 0.80-0.93; P < 0.001) compared to amlodipine. The better impact of S-amlodipine compared to amlodipine on 3P-MACE and 4P-MACE was also observed in the subgroup analysis based on various clinical factors. S-amlodipine showed better adherence than amlodipine (proportions of days covered ≥ 0.8: 96.7% vs . 91.8%; P < 0.001). In conclusion, S-amlodipine appears to potentially reduce the risk of long-term MACE compared to amlodipine in patients with hypertension who have no history of cardiovascular disease. However, these findings should be interpreted with caution and confirmed through further prospective studies.
Kim et al. (Mon,) conduziram uma coorte em Hipertensão (n=45.660). S-amlodipina vs. Amlodipina racêmica foi avaliada no composite de morte por todas as causas, infarto do miocárdio e derrame (3P-MACE) (aHR 0,87, IC 95% 0,81-0,94, p=<0,001). S-amlodipina foi associada a uma redução na incidência de 3P-MACE em comparação com amlodipina racêmica em pacientes com hipertensão (aHR 0,87; IC 95% 0,81-0,94; P<0,001).