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Calcium Channel Blockers in Restoration of Endothelial Function: Systematic Review and Meta-Analysis of Randomized
Miroslav Radenković1, Marko Stojanović1, Milica Prostran1
1Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Insights
Calcium Channel Blockers (CCB) improve endothelial function (EF) compared to thiazide diuretics, but are less effective than ACE Inhibitors or Angiotensin Receptor Blockers in augmenting Flow-Mediated Dilation (FMD).
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Clinical Research
Background:
- Endothelial Function (EF) is crucial for cardiovascular risk assessment and pharmacotherapy.
- Calcium Channel Blockers (CCB) show potential in improving impaired EF.
Purpose of the Study:
- To meta-analyze the effects of CCB on EF, measured by Flow-Mediated Dilation (FMD).
- To compare CCB efficacy against placebo and other cardiovascular drugs.
Main Methods:
- Systematic literature search of randomized, placebo-controlled studies up to November 30, 2017.
- Random-effect model meta-analysis.
- Primary outcome: percentage change in FMD from baseline.
Main Results:
- CCB improved FMD more than thiazide diuretics (TD).
- ACE Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) significantly improved FMD compared to CCB.
- CCB showed similar effects on EF as beta-blockers or placebo.
Conclusions:
- CCB demonstrate a benefit in EF when compared to TD.
- ACEI and ARB are more effective than CCB in enhancing FMD.
- The findings provide insights into comparative drug efficacy for endothelial function.
Background:
Clinical evaluation of the Endothelial Function (EF) is becoming an essential step in the quality assessment of cardiovascular risk prevention and rational pharmacotherapy of cardiovascular disorders. The existing pieces of evidence suggested that Calcium Channel Blockers (CCB) can induce positive effects on impaired EF.
Objective:
To evaluate the effects of CCB on EF, we performed a meta-analysis of available data from randomized and placebo-controlled or other treatment-controlled clinical studies encompassing effects of CCB on EF, as measured by Flow-Mediated Dilation (FMD) of the brachial artery.
Methods:
The relevant clinical studies were searched by systematic exploration of the appropriate databases until November 30, 2017. A random-effect model was conducted. The primary outcome was the percentage change in FMD between the baseline and the final levels in response to investigated drugs.
Results:
Fifteen randomized clinical studies with 33 arms were identified. CCB improved FMD more pronounced than thiazide diuretics - TD (3 studies, 157 participants, WMD=2.08%, 95% CI=0.35-3.80%; P=0.02). Oppositely, ACE Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) notably improved FMD if compared to CCB (CCB vs. ACEI: 5 studies, 533 participants, WMD = -1.62%, 95% CI = -2.74% to -0.50%; P=0.005; and CCB vs. ARB: 9 studies, 669 participants, WMD = -1.52%, 95% CI = -2.22% to -0.81%; P=0.0001). CCB effects on EF were similar to those evoked by beta blockers or placebo.
Conclusion:
CCB improved EF to a more prominent extent only if paralleled to TD, while inversely; ACEI and ARB were more effective in augmenting FMD.
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