Effect of Amlodipine in Stroke and Myocardial infarction: A Systematic Review and Meta-analysis
Shamanna S Iyengar1, Jagdish Chander Mohan2, Saumitra Ray3,4
1Manipal Hospitals, Bangalore, Karnataka, India.
Insights
Amlodipine, a calcium channel blocker, significantly reduces the risk of stroke and myocardial infarction (MI) in patients with hypertension. This finding supports its use in managing cardiovascular complications.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Hypertension is a progressive cardiovascular condition linked to multi-organ dysfunction.
- Stroke and myocardial infarction (MI) are major complications of hypertension, particularly in India.
- Existing antihypertensives like CCBs are effective, but amlodipine's specific impact on stroke and MI requires evaluation.
Purpose of the Study:
- To systematically review and evaluate the effect of amlodipine on stroke and MI in hypertensive patients.
- To assess amlodipine's efficacy in preventing major cardiovascular events in hypertension management.
Main Methods:
- A systematic literature search was conducted for studies published between 2000 and August 2020.
- 13 eligible studies were included in the meta-analysis, following PRISMA criteria.
- Odds ratios and risk ratios were analyzed for amlodipine versus active control/placebo.
Main Results:
- Amlodipine demonstrated a significant effect in reducing the risk of stroke and MI.
- Hazard ratios for amlodipine were <1 for both stroke (0.69-1.04) and MI (0.77-0.98).
- Amlodipine showed better prevention of stroke and MI compared to controls.
Conclusions:
- Pooled analysis of 13 studies indicates amlodipine reduces stroke and MI risk in hypertensive patients.
- Amlodipine, a calcium channel blocker (CCB), is effective in preventing these cardiovascular complications.
- Ten out of 13 studies favored amlodipine, highlighting its superior outcomes.
Introduction:
Hypertension is a progressive cardiovascular condition arising from complex aetiologies. Progression is strongly associated with functional and structural abnormalities that lead to multi-organ dysfunction. Stroke and myocardial infarction are two of the major complications of hypertension in India. Various anti-hypertensive drugs, such as calcium channel blockers (CCBs), beta-blockers, diuretics, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have been the medications of choice for disease management and are known to be effective in reducing the complications of hypertension. CCBs, such as amlodipine, are also currently being used and proven to be effective, although their beneficial effects in the management of complications of hypertension like stroke and myocardial infarction (MI) have yet to be proven. Therefore, the aim of this systematic review was to evaluate the effect of amlodipine on stroke and MI in hypertensive patients.
Methods:
A systematic search of English electronic databases was performed for studies with sufficient statistical power that were published between 2000 andl 30 August 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. A total of 676 papers were screened, and 13 were found eligible to be included in the meta-analysis. Studies that included patients who suffered from MI or stroke and were under amlodipine treatment were included in the analysis. The odds ratio and the risk ratio of amlodipine compared to active control/placebo were noted from the studies and statistically analyzed.
Results:
Amlodipine had a significant effect in reducing stroke and MI in hypertensive patients. Similar to results published in reports, this systematic review proved that the hazard ratio for amlodipine was < 1 for stroke (0.69-1.04) and MI (0.77-0.98), showing that amlodipine accounted for better prevention of stroke and MI.
Conclusion:
In the pooled analysis of data from 12 randomised controlled trials and one double-blinded cohort study measuring the effect of CCBs, we found that the CCB amlodipine reduced the risk of stroke and MI in hypertensive patients. Superior results for amlodipine were found in ten of the 13 studies included in this meta-analysis.
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