Different calcium channel blockers prevent stroke in hypertensive patients: a network meta-analysis of randomized controlled trials

Abstract

Objective To systematically evaluate the effectiveness and safety of different calcium channel blockers (CCBs) in preventing stroke in hypertensive patients. Methods PubMed, Cochrane Library, Embase, Wanfang, CNKI, CBM, and other databases were comprehensively retrieved, and the randomized controlled trials of different CCBs in the prevention of stroke in hypertensive patients were collected. The retrieval time was from the establishment of the databases to November 5, 2018. The languages were limited to Chinese and English. The literature screening, study inclusion, information extraction, and quality evaluation were independently conducted by two professional reviewers. A network diagram was drawn using Stata 13.0, and a meta-analysis of the included studies was performed using the Bayes model of the GeMTC 1.4.3 software. Results A total of 12 studies with 58 468 patients were enrolled. Network meta-analysis showed that nitrendipine (odds ratio 0.63, 95% confidence interval 0.44-0.89) and nifedipine (odds ratio 0.68, 95% confidence interval 0.46-0.92) were statistically significant in reducing the incidence of stroke. Other CCBs were not statistically significant in reducing the incidence of stroke, but had clinical differences. For the effectiveness of applying different CCBs to reduce the incidence of stroke, lacidipine should be preferred, followed by amlodipine, nitrendipine, nifedipine, and felodipine. However, there were no statistically significant differences in the effectiveness of different CCBs in preventing stroke. Conclusion Different CCBs can effectively reduce the incidence of stroke. In terms of specific drug types, lacidipine should be considered first, followed by amlodipine, nitrendipine, nifedipine, and felodipine. Key words: Stroke; Hypertension; Primary prevention; Calcium channel blockers; Antihypertensive agents; Network meta-analysis