Browse > Article
http://dx.doi.org/10.3904/kjim.2014.29.3.315

Amlodipine and cardiovascular outcomes in hypertensive patients: meta-analysis comparing amlodipine-based versus other antihypertensive therapy  

Lee, Seung-Ah (Department of Internal Medicine, Seoul National University Hospital)
Choi, Hong-Mi (Department of Internal Medicine, Seoul National University Hospital)
Park, Hye-Jin (Pfizer Pharmaceuticals Korea, Ltd.)
Ko, Su-Kyoung (Pfizer Pharmaceuticals Korea, Ltd.)
Lee, Hae-Young (Department of Internal Medicine, Seoul National University Hospital)
Publication Information
The Korean journal of internal medicine / v.29, no.3, 2014 , pp. 315-324 More about this Journal
Abstract
Background/Aims: This meta-analysis compared the effects of amlodipine besylate, a charged dihydropyridine-type calcium channel blocker (CCB), with other non-CCB antihypertensive therapies regarding the cardiovascular outcome. Methods: Data from seven long-term outcome trials comparing the cardiovascular outcomes of an amlodipine-based regimen with other active regimens were pooled and analyzed. Results: The risk of myocardial infarction was significantly decreased with an amlodipine-based regimen compared with a non-CCB-based regimen (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.84 to 0.99; p = 0.03). The risk of stroke was also significantly decreased (OR, 0.84; 95% CI, 0.79 to 0.90; p < 0.00001). The risk of heart failure increased slightly with marginal significance for an amlodipine-based regimen compared with a non-CCB-based regimen (OR, 1.14; 95% CI, 0.98 to 1.31; p = 0.08). However, when compared overall with $\beta$-blockers and diuretics, amlodipine showed a comparable risk. Amlodipine-based regimens demonstrated a 10% risk reduction in overall cardiovascular events (OR, 0.90; 95% CI, 0.82 to 0.99; p = 0.02) and total mortality (OR, 0.95; 95% CI, 0.91 to 0.99; p = 0.01). Conclusions: Amlodipine reduced the risk of total cardiovascular events as well as all-cause mortality compared with non-CCB-based regimens, indicating its benefit for high-risk cardiac patients.
Keywords
Amlodipine; Calcium channel blockers; Hypertension; Meta-analysis;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Zanchetti A, Bond MG, Hennig M, et al. Calcium antagonist lacidipine slows down progression of asymptomatic carotid atherosclerosis: principal results of the European Lacidipine Study on Atherosclerosis (ELSA), a randomized, double-blind, long-term trial. Circulation 2002;106:2422-2427.   DOI   ScienceOn
2 Mason RP. Mechanisms of plaque stabilization for the dihydropyridine calcium channel blocker amlodipine: review of the evidence. Atherosclerosis 2002;165:191-199.   DOI
3 Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007;25:1105-1187.   DOI   ScienceOn
4 Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009;338:b1665.   DOI
5 Rothwell PM, Howard SC, Dolan E, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010;375:895-905.   DOI   ScienceOn
6 Dahlof B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendrof lumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005;366:895-906.   DOI   ScienceOn
7 Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001;345:851-860.   DOI   ScienceOn
8 Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004;363:2022-2031.   DOI   ScienceOn
9 Ogihara T, Nakao K, Fukui T, et al. Effects of candesartan compared with amlodipine in hypertensive patients with high cardiovascular risks: candesartan antihypertensive survival evaluation in Japan trial. Hypertension 2008;51:393-398.   DOI
10 Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta- analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta- analyses. Lancet 1999;354:1896-1900.   DOI   ScienceOn
11 Sowers JR. Comorbidity of hypertension and diabetes: the fosinopril versus amlodipine cardiovascular events trial (FACET). Am J Cardiol 1998;82:15R-19R.
12 Turnbull FM, Woodward M. Calcium antagonists revisited. J Hypertens 2009;27:1121-1122.   DOI
13 Verdecchia P, Reboldi G, Angeli F, et al. Angiotensin- converting enzyme inhibitors and calcium channel blockers for coronary heart disease and stroke prevention. Hypertension 2005;46:386-392.   DOI   ScienceOn
14 Makarounas-Kirchmann K, Glover-Koudounas S, Ferrari P. Results of a meta-analysis comparing the tolerability of lercanidipine and other dihydropyridine calcium channel blockers. Clin Ther 2009;31:1652-1663.   DOI
15 IMS Health. The most prescribed drugs according to IMS Health. Danbury (CT): IMS Health, 2011.
16 ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group; The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288:2981-2997.   DOI   ScienceOn
17 Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008;359:2417-2428.   DOI   ScienceOn
18 Wright JT Jr, Bakris G, Greene T, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 2002;288:2421-2431.   DOI   ScienceOn
19 Costanzo P, Perrone-Filardi P, Petretta M, et al. Calcium channel blockers and cardiovascular outcomes: a meta- analysis of 175,634 patients. J Hypertens 2009;27:1136-1151.   DOI
20 Pahor M, Psaty BM, Alderman MH, et al. Health outcomes associated with calcium antagonists compared with other f irst-line antihypertensive therapies: a meta-analysis of randomised controlled trials. Lancet 2000;356:1949-1954.   DOI
21 Blood Pressure Lowering Treatment Trialists' Collaboration, Turnbull F, Neal B, et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ 2008;336:1121-1123.   DOI   ScienceOn
22 Frishman WH. Calcium channel blockers: differences between subclasses. Am J Cardiovasc Drugs 2007;7 Suppl 1:17-23.   DOI
23 Lee HY, Park JB. Prevalence and risk factors of masked hypertension identified by multiple self-blood pressure measurement. Hypertension 2008;52:e137-e138.   DOI