Amlodipine provided greater protection against stroke (-19%, P<0.0001) and myocardial infarction (-7%, P=0.03) than other antihypertensive drugs, largely driven by blood pressure differences.
Meta-Analysis (n=94,338)
Does amlodipine or angiotensin receptor blockers reduce stroke and myocardial infarction in patients with hypertension, coronary artery disease, or diabetic nephropathy?
Amlodipine provides superior protection against stroke and myocardial infarction compared to other antihypertensives, an effect largely driven by differences in achieved blood pressure.
Effect estimate: -19% for stroke, -7% for MI (amlodipine vs other drugs)
p-value: p=<0.0001 for stroke, 0.03 for MI
In the present quantitative overview of outcome trials, we investigated the efficacy of amlodipine or angiotensin receptor blockers in the prevention of stroke and myocardial infarction in patients with hypertension, coronary artery disease, or diabetic nephropathy. The analysis included 12 trials of 94 338 patients. The analysis of trials involving an amlodipine group showed that amlodipine provided more protection against stroke and myocardial infarction than other antihypertensive drugs, including angiotensin receptor blockers (-19%, P or =0.14). The within-trial between-group difference in achieved systolic pressure ranged from -1.1 to +4.7 mm Hg for trials involving an amlodipine group and from -2.8 to +4.0 mm Hg for trials involving an angiotensin receptor blocker group. The metaregression analysis correlating odds ratios with blood pressure differences showed a negative relationship (regression coefficients: -3% to -8%), which reached statistical significance (regression coefficient: -6%; P=0.01) for stroke in trials involving an amlodipine group. In conclusion, blood pressure differences largely accounted for cardiovascular outcome.
Wang et al. (Tue,) conducted a meta-analysis in Hypertension, coronary artery disease, or diabetic nephropathy (n=94,338). Amlodipine or angiotensin receptor blockers vs. Other antihypertensive drugs or placebo was evaluated on Stroke and myocardial infarction (-19% for stroke, -7% for MI (amlodipine vs other drugs), p=<0.0001 for stroke, 0.03 for MI). Amlodipine provided greater protection against stroke (-19%, P<0.0001) and myocardial infarction (-7%, P=0.03) than other antihypertensive drugs, largely driven by blood pressure differences.
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