Efficacy and safety of dual calcium channel blockade for the treatment of hypertension: A meta-analysis

Carlos L. Alviar, Santhosh Devarapally, Girish N. Nadkarni, Jorge E. Romero, Alexandre M. Benjo, Fahad Javed, Bryan Doherty, Hyuensok Kang, Sripal Bangalore, Franz H. Messerli

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Abstract

Background Dual calcium-channel blocker (CCB) with a dihydropyridine (DHP) and a nondihydropyridine (NDHP) has been proposed for hypertension treatment. However, the safety and efficacy of this approach is not well known. Methods A MEDLINE/EMBASE/CENTRAL search for randomized clinical trials published on this topic from 1966 to February 2012 was performed. Efficacy outcomes of decrease in systolic (SBP) and diastolic (DBP) blood pressures from baseline, changes in heart rate (HR), and adverse effects were compared between dual CCB therapy vs. DHP or NDHP. SBP, DBP, and HR were expressed as weighted mean deviation (WMD). Results A total of 6 studies with 153 patients were included. Dual CCB produced a significantly greater reduction in SBP (21.6±9.2 mmHg) from baseline than DHP (10.3±6.3 mmHg (WMD = 10.9 mmHg, P < 0.0001)) or NDHP (8.9±4.2 mmHg (WMD = 14.1 mmHg, P = 0.002)). Dual CCB therapy reduced DBP from baseline more than either monotherapy (dual CCB = 17.5±10.2 mmHg vs. DHP = 11.6±8.7 mmHg, WMD = 5.5 mmHg, P < 0.001; and NDHP = 10.5±5.6 mmHg, WMD = 5.3 mmHg, P = 0.03). Dual CCB therapy had significantly lower HR compared to DHP (P < 0.001) but was comparable to NDHP (P = 0.12) (Delta change dual CCB =-4.0±3.5 vs. DHP =-2.0±1.5 and NDHP =-6.0±5.0 beats/min). Dual CCB therapy did not increase adverse effects. Conclusions Dual CCB therapy lowers blood pressure significantly better than CCB monotherapy, without an increase in adverse events. However, given the lack of long-term outcome data on efficacy and safety, dual CCB therapy should be used with restraint, if at all. Large-scale long-term trials are needed to further evaluate such a strategy.

Original languageEnglish (US)
Pages (from-to)287-297
Number of pages11
JournalAmerican Journal of Hypertension
Volume26
Issue number2
DOIs
StatePublished - Feb 2013

Fingerprint

Calcium Channel Blockers
Calcium Channels
Meta-Analysis
Hypertension
Safety
Therapeutics
Heart Rate
Blood Pressure
MEDLINE
1,4-dihydropyridine
Randomized Controlled Trials

Keywords

  • blood pressure
  • calcium channel blockers
  • combination
  • dihydropyridine
  • dual therapy
  • hypertension
  • nondihydropyridine

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Efficacy and safety of dual calcium channel blockade for the treatment of hypertension : A meta-analysis. / Alviar, Carlos L.; Devarapally, Santhosh; Nadkarni, Girish N.; Romero, Jorge E.; Benjo, Alexandre M.; Javed, Fahad; Doherty, Bryan; Kang, Hyuensok; Bangalore, Sripal; Messerli, Franz H.

In: American Journal of Hypertension, Vol. 26, No. 2, 02.2013, p. 287-297.

Research output: Contribution to journalArticle

Alviar, CL, Devarapally, S, Nadkarni, GN, Romero, JE, Benjo, AM, Javed, F, Doherty, B, Kang, H, Bangalore, S & Messerli, FH 2013, 'Efficacy and safety of dual calcium channel blockade for the treatment of hypertension: A meta-analysis', American Journal of Hypertension, vol. 26, no. 2, pp. 287-297. https://doi.org/10.1093/ajh/hps009
Alviar, Carlos L. ; Devarapally, Santhosh ; Nadkarni, Girish N. ; Romero, Jorge E. ; Benjo, Alexandre M. ; Javed, Fahad ; Doherty, Bryan ; Kang, Hyuensok ; Bangalore, Sripal ; Messerli, Franz H. / Efficacy and safety of dual calcium channel blockade for the treatment of hypertension : A meta-analysis. In: American Journal of Hypertension. 2013 ; Vol. 26, No. 2. pp. 287-297.
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abstract = "Background Dual calcium-channel blocker (CCB) with a dihydropyridine (DHP) and a nondihydropyridine (NDHP) has been proposed for hypertension treatment. However, the safety and efficacy of this approach is not well known. Methods A MEDLINE/EMBASE/CENTRAL search for randomized clinical trials published on this topic from 1966 to February 2012 was performed. Efficacy outcomes of decrease in systolic (SBP) and diastolic (DBP) blood pressures from baseline, changes in heart rate (HR), and adverse effects were compared between dual CCB therapy vs. DHP or NDHP. SBP, DBP, and HR were expressed as weighted mean deviation (WMD). Results A total of 6 studies with 153 patients were included. Dual CCB produced a significantly greater reduction in SBP (21.6±9.2 mmHg) from baseline than DHP (10.3±6.3 mmHg (WMD = 10.9 mmHg, P < 0.0001)) or NDHP (8.9±4.2 mmHg (WMD = 14.1 mmHg, P = 0.002)). Dual CCB therapy reduced DBP from baseline more than either monotherapy (dual CCB = 17.5±10.2 mmHg vs. DHP = 11.6±8.7 mmHg, WMD = 5.5 mmHg, P < 0.001; and NDHP = 10.5±5.6 mmHg, WMD = 5.3 mmHg, P = 0.03). Dual CCB therapy had significantly lower HR compared to DHP (P < 0.001) but was comparable to NDHP (P = 0.12) (Delta change dual CCB =-4.0±3.5 vs. DHP =-2.0±1.5 and NDHP =-6.0±5.0 beats/min). Dual CCB therapy did not increase adverse effects. Conclusions Dual CCB therapy lowers blood pressure significantly better than CCB monotherapy, without an increase in adverse events. However, given the lack of long-term outcome data on efficacy and safety, dual CCB therapy should be used with restraint, if at all. Large-scale long-term trials are needed to further evaluate such a strategy.",
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T1 - Efficacy and safety of dual calcium channel blockade for the treatment of hypertension

T2 - A meta-analysis

AU - Alviar, Carlos L.

AU - Devarapally, Santhosh

AU - Nadkarni, Girish N.

AU - Romero, Jorge E.

AU - Benjo, Alexandre M.

AU - Javed, Fahad

AU - Doherty, Bryan

AU - Kang, Hyuensok

AU - Bangalore, Sripal

AU - Messerli, Franz H.

PY - 2013/2

Y1 - 2013/2

N2 - Background Dual calcium-channel blocker (CCB) with a dihydropyridine (DHP) and a nondihydropyridine (NDHP) has been proposed for hypertension treatment. However, the safety and efficacy of this approach is not well known. Methods A MEDLINE/EMBASE/CENTRAL search for randomized clinical trials published on this topic from 1966 to February 2012 was performed. Efficacy outcomes of decrease in systolic (SBP) and diastolic (DBP) blood pressures from baseline, changes in heart rate (HR), and adverse effects were compared between dual CCB therapy vs. DHP or NDHP. SBP, DBP, and HR were expressed as weighted mean deviation (WMD). Results A total of 6 studies with 153 patients were included. Dual CCB produced a significantly greater reduction in SBP (21.6±9.2 mmHg) from baseline than DHP (10.3±6.3 mmHg (WMD = 10.9 mmHg, P < 0.0001)) or NDHP (8.9±4.2 mmHg (WMD = 14.1 mmHg, P = 0.002)). Dual CCB therapy reduced DBP from baseline more than either monotherapy (dual CCB = 17.5±10.2 mmHg vs. DHP = 11.6±8.7 mmHg, WMD = 5.5 mmHg, P < 0.001; and NDHP = 10.5±5.6 mmHg, WMD = 5.3 mmHg, P = 0.03). Dual CCB therapy had significantly lower HR compared to DHP (P < 0.001) but was comparable to NDHP (P = 0.12) (Delta change dual CCB =-4.0±3.5 vs. DHP =-2.0±1.5 and NDHP =-6.0±5.0 beats/min). Dual CCB therapy did not increase adverse effects. Conclusions Dual CCB therapy lowers blood pressure significantly better than CCB monotherapy, without an increase in adverse events. However, given the lack of long-term outcome data on efficacy and safety, dual CCB therapy should be used with restraint, if at all. Large-scale long-term trials are needed to further evaluate such a strategy.

AB - Background Dual calcium-channel blocker (CCB) with a dihydropyridine (DHP) and a nondihydropyridine (NDHP) has been proposed for hypertension treatment. However, the safety and efficacy of this approach is not well known. Methods A MEDLINE/EMBASE/CENTRAL search for randomized clinical trials published on this topic from 1966 to February 2012 was performed. Efficacy outcomes of decrease in systolic (SBP) and diastolic (DBP) blood pressures from baseline, changes in heart rate (HR), and adverse effects were compared between dual CCB therapy vs. DHP or NDHP. SBP, DBP, and HR were expressed as weighted mean deviation (WMD). Results A total of 6 studies with 153 patients were included. Dual CCB produced a significantly greater reduction in SBP (21.6±9.2 mmHg) from baseline than DHP (10.3±6.3 mmHg (WMD = 10.9 mmHg, P < 0.0001)) or NDHP (8.9±4.2 mmHg (WMD = 14.1 mmHg, P = 0.002)). Dual CCB therapy reduced DBP from baseline more than either monotherapy (dual CCB = 17.5±10.2 mmHg vs. DHP = 11.6±8.7 mmHg, WMD = 5.5 mmHg, P < 0.001; and NDHP = 10.5±5.6 mmHg, WMD = 5.3 mmHg, P = 0.03). Dual CCB therapy had significantly lower HR compared to DHP (P < 0.001) but was comparable to NDHP (P = 0.12) (Delta change dual CCB =-4.0±3.5 vs. DHP =-2.0±1.5 and NDHP =-6.0±5.0 beats/min). Dual CCB therapy did not increase adverse effects. Conclusions Dual CCB therapy lowers blood pressure significantly better than CCB monotherapy, without an increase in adverse events. However, given the lack of long-term outcome data on efficacy and safety, dual CCB therapy should be used with restraint, if at all. Large-scale long-term trials are needed to further evaluate such a strategy.

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KW - calcium channel blockers

KW - combination

KW - dihydropyridine

KW - dual therapy

KW - hypertension

KW - nondihydropyridine

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