HEALTH
OUTCOMES ASSOCIATED WITH CALCIUM ANTAGONISTS COMPARED WITH OTHER FIRST-LINE
ANTIHYPERTENSIVE THERAPIES: A META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS.
Pahor
M, et al. Lancet 2000 Dec 9;356(9246):1949-54
BACKGROUND:
Several observational studies and individual randomised trials in hypertension
have suggested that, compared with other drugs, calcium antagonists may be
associated with a higher risk of coronary events, despite similar
blood-pressure control. The aim of this meta-analysis was to compare the
effects of calcium antagonists and other antihypertensive drugs on major
cardiovascular events.
METHODS:
We undertook a meta-analysis of trials in hypertension that assessed
cardiovascular events and included at least 100 patients, who were randomly
assigned intermediate-acting or long-acting calcium antagonists or other
antihypertensive drugs and who were followed up for at least 2 years.
FINDINGS:
The nine eligible trials included 27,743 participants. Calcium antagonists and
other drugs achieved similar control of both systolic and diastolic blood
pressure. Compared with patients assigned diuretics, beta-blockers,
angiotensin-converting-enzyme inhibitors, or clonidine (n=15,044), those
assigned calcium antagonists (n=12,699) had a significantly higher risk of
acute myocardial infarction (odds ratio 1.26 [95% CI 1.11-1.43], p=0.0003),
congestive heart failure (1.25 [1.07-1.46], p=0.005), and major cardiovascular
events (1.10 [1.02-1.18], p=0.018). The treatment differences were within the play
of chance for the outcomes of stroke (0.90 [0.80-1.02], p=0.10) and all-cause
mortality (1.03 [0.94-1.13], p=0.54).
INTERPRETATION:
In randomised controlled trials, the large available database suggests that
calcium antagonists are inferior to other types of antihypertensive drugs as
first-line agents in reducing the risks of several major complications of
hypertension. On the basis of these data, the longer-acting calcium antagonists
cannot be recommended as first-line therapy for hypertension.