Key result
S-amlodipine linked to ~13% lower 3P-MACE risk versus racemic amlodipine.
Why the study?
Although S-amlodipine lowers blood pressure similarly with fewer side effects than racemic amlodipine, data on its impact on long-term cardiovascular prognosis were lacking.
Does S-amlodipine reduce long-term major adverse cardiovascular events compared to racemic amlodipine in patients with hypertension and no prior cardiovascular disease?
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?
Effect estimate: aHR 0.87 (95% CI 0.81-0.94)
p-value: p=<0.001
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.
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Hypothesis-generating for lower MACE with S-amlodipine in hypertension; randomized trials needed before practice change.
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. (2026) conducted a cohort in Hypertension (n=45,660). S-amlodipine vs. Racemic amlodipine was evaluated on Composite of all-cause death, myocardial infarction, and stroke (3P-MACE) (aHR 0.87, 95% CI 0.81-0.94, p=<0.001). 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).
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