Key result
Initial therapy with a calcium antagonist significantly reduced the risk of stroke by 8% compared with an initial diuretic or beta blocker, but increased the risk of heart failure by 29%.
Why the study?
Do calcium antagonists reduce stroke compared to other antihypertensives or placebo in patients with elevated blood pressure?
Meta-Analysis
Do calcium antagonists reduce stroke compared to other antihypertensives or placebo in patients with elevated blood pressure?
Calcium antagonists significantly reduce stroke risk by 9% compared to diuretics or beta blockers, but increase the risk of heart failure by 29%.
Favors calcium antagonists over diuretics or beta blockers for stroke prevention in hypertension despite heart failure risk; reinforces class-specific outcome differences.
Lowering elevated blood pressure significantly reduces the risk of stroke, but whether any specific type of antihypertensive medication is better for this purpose, independent of blood pressure-lowering effects, is controversial. Compared with placebo or no treatment, the point estimate for stroke reduction is the largest with calcium antagonists; all such studies used dihydropyridine compounds. When all clinical trials published through December 2004 are combined in meta-analysis, stroke is not significantly reduced when an initial dihydropyridine or nondihydropyridine calcium antagonist is compared with an initial diuretic or beta blocker, but when the two subclasses are combined, stroke reduction (9%) is significant. The risk of heart failure, however, is significantly increased (by 29%) with the initial calcium antagonist. These estimates may change as newer trials are reported.
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Elliott et al. (2005) conducted a meta-analysis in Hypertension. Calcium antagonists vs. Diuretic or beta blocker was evaluated on Fatal or nonfatal stroke (8% reduction, 95% CI 0.9%-15%, p=<0.039). Initial therapy with a calcium antagonist significantly reduced the risk of stroke by 8% compared with an initial diuretic or beta blocker, but increased the risk of heart failure by 29%.
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