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Evidence summaries

Calcium Channel Blockers Versus other Classes of Drugs for Hypertension

First-line CCBs appear not to be significantly different from any of the other classes of antihypertensive drugs for total mortality. CCBs appear to reduce major cardiovascular events, stroke, and cardiovascular mortality compared to beta-blockers, and increase major cardiovascular events and congestive heart failure events compared to diuretics. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 23 studies (18 dihydropyridines, 4 non-dihydropyridines, 1 not specified) with a total of 153 849 subjects. All-cause mortality was not different between first-line calcium channel blockers (CCBs) and any other first-line antihypertensive classes.. CCBs reduced the following outcomes as compared to β-blockers: major cardiovascular events (RR 0.84, 95% CI 0.77 to 0.92), stroke (RR 0.77, 95% CI 0.67 to 0.88) and cardiovascular mortality (RR 0.90, 95% CI 0.81 to 0.99, statistical heterogeneity, I2 =62%). CCBs increased major cardiovascular events (RR 1.05, 95% CI 1.00 to 1.09, p = 0.03) and congestive heart failure events (RR 1.37, 95% CI 1.25 to 1.51) as compared to diuretics. CCBs reduced stroke (RR 0.90, 95% CI 0.81 to 0.99) as compared to ACE inhibitors and reduced myocardial infarction (RR 0.82, 95% CI 0.72 to 0.94) as compared to ARBs. CCBs also increased congestive heart failure events as compared to ACE inhibitors (RR 1.16, 95% CI 1.06 to 1.28) and ARBs (RR 1.20, 95% CI 1.06 to 1.36, statistical heterogeneity, I2 =66%).

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment).

References

  • Zhu J, Chen N, Zhou M et al. Calcium channel blockers versus other classes of drugs for hypertension. Cochrane Database Syst Rev 2022;(1):CD003654. [PubMed]

Primary/Secondary Keywords