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.
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?
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.
Effect estimate: RR 1.25 (95% CI 1.05-1.49)
p-value: p=0.019
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.
Chaugai et al. (Tue,) 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.