Abstract
BackgroundHypertension is a major risk factor for the development of stroke. It is well known that lowering blood pressure decreases the risk of stroke in people with moderate to severe hypertension. However, the specific effects of calcium channel blockers (CCBs) against stroke in patients with hypertension as compared to no treatment and other antihypertensive drug classes are not known.Methods and FindingsThis systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated CCBs effect on stroke in patients with hypertension in studies of CCBs versus placebo, angiotensin-converting-enzyme inhibitors (ACEIs), β-adrenergic blockers, and diuretics. The PUBMED, MEDLINE, EMBASE, OVID, CNKI, MEDCH, and WANFANG databases were searched for trials published in English or Chinese during the period January 1, 1996 to July 31, 2012. A total of 177 reports were collected, among them 31 RCTs with 273,543 participants (including 130,466 experimental subjects and 143,077 controls) met the inclusion criteria. In these trials a total of 9,550 stroke events (4,145 in experimental group and 5,405 in control group) were reported. CCBs significantly decreased the incidence of stroke compared with placebo (OR = 0.68, 95% CI 0.61–0.75, p<1×10−5), β-adrenergic blockers combined with diuretics (OR = 0.89, 95% CI 0.83–0.95, p = 7×10−5) and β-adrenergic blockers (OR = 0.79, 95% CI 0.72–0.87, p<1×10−5), statistically significant difference was not found between CCBs and ACEIs (OR = 0.92, 95% CI 0.8–1.02, p = 0.12) or diuretics (OR = 0.95, 95% CI 0.84–1.07, p = 0.39).ConclusionIn a pooled analysis of data of 31 RCTs measuring the effect of CCBs on stroke, CCBs reduced stroke more than placebo and β-adrenergic blockers, but were not different than ACEIs and diuretics. More head to head RCTs are warranted.
Highlights
Hypertension (MIM #14500) is one of the most common chronic diseases, and the most frequent reason for people to consult their doctor and take medication
Because each study may have insufficient power to detect the effect of calcium channel blockers against stroke in the patients with hypertension; a metastudy to accumulate data from different studies may address this issue, and the specific effects of CCBs against stroke in patients with hypertension as compared to no treatment and other antihypertensive drug classes are not known
Results of subgroups analyses indicated that the CCBs were more effective than b-adrenergic blockers alone (OR = 0.79, 95% CI 0.72–0.87, p,161025), b-adrenergic blockers combined with diuretics (OR = 0.89, 95% CI 0.83–0.95, p = 761025), but not diuretics alone (OR = 0.95, 95% CI 0.84–1.07, p = 0.39) in the prevention of stroke
Summary
Hypertension (MIM #14500) is one of the most common chronic diseases, and the most frequent reason for people to consult their doctor and take medication. Despite the widespread use of blood-pressure-lowering agents which one is better against the development of stroke is unclear [3]. The major goal of this work was to perform a systematic review and a metaanalysis of the published data and to figure out whether calciumchannel blockers are better than other first-line antihypertensive agents in the prevention of stroke, as well as to quantify the potential heterogeneity between different studies. It is well known that lowering blood pressure decreases the risk of stroke in people with moderate to severe hypertension. The specific effects of calcium channel blockers (CCBs) against stroke in patients with hypertension as compared to no treatment and other antihypertensive drug classes are not known
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