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).
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