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Health outcomes associated with calcium antagonists compared with other first-line antihypertensive therapies: a
M Pahor1, B M Psaty, M H Alderman
1Sticht Center on Aging, Department of Internal Medicine, Wake Forest University, Winston Salem, NC 27157, USA. mpahor@wfubmc.edu
Insights
Calcium antagonists, used for hypertension, show a higher risk of heart attack and heart failure compared to other drugs. These findings suggest they are not ideal as a first-line treatment for high blood pressure.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Observational studies and trials suggest calcium antagonists may increase coronary event risk in hypertension.
- This meta-analysis aimed to compare cardiovascular event risks between calcium antagonists and other antihypertensives.
Purpose of the Study:
- To compare the safety and efficacy of calcium antagonists versus other antihypertensive drugs regarding major cardiovascular events.
- To evaluate the risk of specific adverse events, including myocardial infarction and heart failure.
Main Methods:
- Meta-analysis of nine randomized controlled trials with at least 100 patients each.
- Included trials followed participants for a minimum of 2 years, comparing calcium antagonists with other antihypertensive classes.
Main Results:
- Calcium antagonists and other drugs provided similar blood pressure control.
- Compared to diuretics, beta-blockers, ACE inhibitors, or clonidine, calcium antagonists were associated with a significantly higher risk of acute myocardial infarction (OR 1.26) and congestive heart failure (OR 1.25).
- A significantly higher risk of major cardiovascular events was observed with calcium antagonists (OR 1.10).
Conclusions:
- Calcium antagonists are inferior to other first-line antihypertensive agents in reducing major hypertension-related complications.
- Longer-acting calcium antagonists are not recommended as initial therapy for hypertension based on current evidence.
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.
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