Among dihydropyridine calcium channel blockers, nifedipine ranked highest (SUCRA 81.8%) and lacidipine lowest (SUCRA 12.8%) for inducing peripheral edema.
Meta-Analysis (n=56,283)
Do different dihydropyridine calcium channel blockers and their combinations with renin-angiotensin system blockers differ in their rates of peripheral edema in patients with cardiovascular indications?
Nifedipine carries the highest risk of peripheral edema among DHPCCBs, while lacidipine carries the lowest, and combining DHPCCBs with ACEIs, ARBs, or diuretics mitigates this risk compared to monotherapy.
Dihydropyridine calcium channel blockers (DHPCCBs) are widely used to treat hypertension and chronic coronary artery disease. One common adverse effect of DHPCCBs is peripheral edema, particularly of the lower limbs. The side effect could lead to dose reduction or discontinuation of the medication. The combination of DHPCCBs and renin-angiotensin system blockers has shown to reduce the risk of DHPCCBs-associated peripheral edema compared with DHPCCBs monotherapy. We performed the current systematic review and network meta-analysis of randomized controlled trials (RCTs) to estimate the rate of peripheral edema with DHPCCBs as a class and with individual DHPCCBs and the ranking of the reduction of peripheral edema. The effects of renin-angiotensin system blockers on DHPCCBs network meta-analysis were created to analyze the ranking of the reduction of peripheral edema. A total of 3312 publications were identified and 71 studies with 56,283 patients were included. Nifedipine ranked highest in inducing peripheral edema (SUCRA 81.8%) and lacidipine (SUCRA 12.8%) ranked the least. All DHPCCBs except lacidipine resulted in higher relative risk (RR) of peripheral edema compared with placebo. Nifedipine plus angiotensin receptor blocker (SUCRA: 92.3%) did not mitigate peripheral edema and amlodipine plus angiotensin-converting enzyme inhibitors (SUCRA: 16%) reduced peripheral edema the most. Nifedipine ranked the highest and lacidipine ranked the lowest amongst DHPCCBs for developing peripheral edema when used for cardiovascular indications. The second or higher generation of DHPCCBs combination with ACEIs or ARBs or diuretics lowered the chance of peripheral edema development compared to single DHPCCB treatment.
Liang et al. (Wed,) conducted a meta-analysis in Hypertension and chronic coronary artery disease (n=56,283). Dihydropyridine calcium channel blockers (DHPCCBs) vs. Placebo or other DHPCCBs was evaluated on Peripheral edema. Among dihydropyridine calcium channel blockers, nifedipine ranked highest (SUCRA 81.8%) and lacidipine lowest (SUCRA 12.8%) for inducing peripheral edema.