Karen C Tran1, Alexander A Leung2, Karen L Tang3, Hude Quan4, Nadia A Khan5. 1. Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: karen.tran4@vch.ca. 2. Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 3. Department of Medicine, University of Calgary, Calgary, Alberta, Canada. 4. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 5. Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.
Abstract
BACKGROUND: Whether calcium channel blockers exert a greater effect on cardiovascular risk reduction in Asian populations than other antihypertensive agents is unclear. We conducted a meta-analysis of hypertension trials of dihydropyridine calcium channel blockers in Asian populations to clarify this association. METHODS: EMBASE, MEDLINE, and Cochrane databases were searched (from inception to August 2016) for randomized controlled trials on cardiovascular death, major adverse cardiovascular events, stroke, congestive heart failure, and coronary revascularization in Asian persons with hypertension. We identified 9 trials that reported data specific to Asian populations (N = 29,643). These trials included 1 placebo-controlled trial and 8 active comparator trials; of these, 5 had angiotensin receptor blockers as the active comparator. RESULTS: One placebo-controlled trial (n = 9711) showed significantly reduced cardiovascular mortality, major adverse cardiovascular events, and stroke with calcium channel blockers. Among 8 active comparator trials (n = 19,932), there were no significant differences in mortality (relative risk [RR], 1.10; 95% confidence interval [CI], 0.72-1.67; I2 = 0.0%), major adverse cardiovascular events (RR, 1.02; 95% CI, 0.90-1.15; I2 = 0.0%), stroke (RR, 0.97; 95% CI, 0.80-1.17; I2 = 0.0%), congestive heart failure (RR, 1.01; 95% CI, 0.51-2.00; I2 = 53.7), or coronary revascularization rates (RR, 0.98; 95% CI, 0.76-1.25; I2 = 0.0%) in the calcium channel blocker group compared with other antihypertensive agents. When restricting the meta-analysis to angiotensin receptor blocker comparators (n = 10,384), there were no significant differences in cardiovascular outcomes. CONCLUSIONS: There is no evidence that dihydropyridine calcium channel blockers are superior to other antihypertensive agents in Asian populations for the treatment of hypertension.
BACKGROUND: Whether calcium channel blockers exert a greater effect on cardiovascular risk reduction in Asian populations than other antihypertensive agents is unclear. We conducted a meta-analysis of hypertension trials of dihydropyridine calcium channel blockers in Asian populations to clarify this association. METHODS: EMBASE, MEDLINE, and Cochrane databases were searched (from inception to August 2016) for randomized controlled trials on cardiovascular death, major adverse cardiovascular events, stroke, congestive heart failure, and coronary revascularization in Asian persons with hypertension. We identified 9 trials that reported data specific to Asian populations (N = 29,643). These trials included 1 placebo-controlled trial and 8 active comparator trials; of these, 5 had angiotensin receptor blockers as the active comparator. RESULTS: One placebo-controlled trial (n = 9711) showed significantly reduced cardiovascular mortality, major adverse cardiovascular events, and stroke with calcium channel blockers. Among 8 active comparator trials (n = 19,932), there were no significant differences in mortality (relative risk [RR], 1.10; 95% confidence interval [CI], 0.72-1.67; I2 = 0.0%), major adverse cardiovascular events (RR, 1.02; 95% CI, 0.90-1.15; I2 = 0.0%), stroke (RR, 0.97; 95% CI, 0.80-1.17; I2 = 0.0%), congestive heart failure (RR, 1.01; 95% CI, 0.51-2.00; I2 = 53.7), or coronary revascularization rates (RR, 0.98; 95% CI, 0.76-1.25; I2 = 0.0%) in the calcium channel blocker group compared with other antihypertensive agents. When restricting the meta-analysis to angiotensin receptor blocker comparators (n = 10,384), there were no significant differences in cardiovascular outcomes. CONCLUSIONS: There is no evidence that dihydropyridine calcium channel blockers are superior to other antihypertensive agents in Asian populations for the treatment of hypertension.
Authors: Omar Mukhtar; Joseph Cheriyan; John R Cockcroft; David Collier; James M Coulson; Indranil Dasgupta; Luca Faconti; Mark Glover; Anthony M Heagerty; Teck K Khong; Gregory Y H Lip; Adrian P Mander; Mellone N Marchong; Una Martin; Barry J McDonnell; Carmel M McEniery; Sandosh Padmanabhan; Manish Saxena; Peter J Sever; Julian I Shiel; Julie Wych; Phil J Chowienczyk; Ian B Wilkinson Journal: Am Heart J Date: 2018-05-20 Impact factor: 4.749