Key result
Amlodipine lowers stroke risk ~17% vs alternative therapies, while intermediate-acting agents increase HF and MI.
Why the study?
Do long- and intermediate-acting dihydropyridine calcium channel blockers affect the risk of heart failure, stroke, and AMI compared to major alternative antihypertensive therapies in patients with hypertension?
Meta-Analysis (n=80,483)
Do long- and intermediate-acting dihydropyridine calcium channel blockers affect the risk of heart failure, stroke, and AMI compared to major alternative antihypertensive therapies in patients with hypertension?
Effect estimate: RR 1.25 (95% CI 1.05-1.49)
p-value: p=0.019
Amlodipine offers greater protection against stroke but increases heart failure risk compared to other antihypertensives, while intermediate-acting CCBs increase the risk of both heart failure and AMI.
May favor amlodipine for stroke prevention in hypertension despite heart failure risk; extends evidence of differential long- versus intermediate-acting CCB effects.
BACKGROUND: Dihydropyridine calcium channel blockers are a heterogeneous group of antihypertensive drugs. Long-acting dihydropyridine agent amlodipine is widely used for monotherapy and combination therapy for hypertension in clinical practice, while intermediate-acting dihydropyridine agents have shown inconsistent results in randomized clinical trials (RCTs). METHODS AND RESULTS: A meta-analysis of 18 RCTs enrolling a total of 80,483 patients with hypertension followed for a mean of 51.4 months was performed. Amlodipine therapy was associated with 25% higher risk of heart failure (relative risk [RR]: 1.25, 95% confidence interval [CI], 1.05-1.49, P = .019) but 17% lower risk of stroke (RR: 0.83, [95% CI, 0.72-0.97], P = .009) without statistically significant effect on acute myocardial infarction (AMI) compared to major alternative antihypertensive therapy (MAAT), including β-blocker, diuretic, angiotensin-converting enzyme inhibitor, or angiotensin-receptor blocker. Intermediate-acting dihydropyridine calcium channel blocker therapy was associated with 25% higher risk of heart failure (RR: 1.25, [95% CI, 1.06-1.47], 0.005, P = .005) and 26% higher risk of AMI (RR: 1.26, [95% CI, 1.05-1.51], 0.019, P = .019) compared to MAAT. Results of the subgroup analysis suggested that the intermediate-acting dihydropyridine calcium channel blocker was associated with higher risk of heart failure (RR: 1.30, [95% CI, 1.08-1.56], P = .005) and AMI (RR: 1.50, [95% CI, 1.01-2.22], P = .043) compared to renin-angiotensin system blockers and a trend toward higher risk of AMI (RR: 1.17, [95% CI, 0.99-1.38], P = .064) compared to conventional therapy, including β-blockers and diuretics. Meta-regression analyses suggested that long-acting dihydropyridine calcium channel blocker is associated with lower risk of AMI ( B: -0.327, [95% CI, -0.530 to -0.123], P = .002) with a trend toward lower risk of stroke ( B: -0.203, [95% CI, -0.410 to 0.003] P = .054). CONCLUSIONS: This study suggests that Amlodipine offers greater protection against major complications of hypertension compared to intermediate-acting dihydropyridine calcium channel blockers.
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Chaugai et al. (2018) conducted a meta-analysis in Hypertension (n=80,483). Long-acting (amlodipine) and intermediate-acting dihydropyridine calcium channel blockers vs. Major alternative antihypertensive therapy (MAAT) was evaluated on Heart failure (RR 1.25, 95% CI 1.05-1.49, p=0.019). Amlodipine lowered stroke risk (RR 0.83; 95% CI 0.72-0.97) vs alternative therapies, whereas intermediate-acting agents increased risks of heart failure and acute myocardial infarction.
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