Calcium channel blockers and cardiovascular outcomes: a meta-analysis of 175 634 patients

Costanzo, Pierluigi; Perrone‐Filardi, Pasquale; Petretta, Mario; Marciano, Caterina; Vassallo, Enrico; Gargiulo, Paola; Paolillo, Stefania; Petretta, Andrea; Chiariello, Massimo

doi:10.1097/hjh.0b013e3283281254

Cited by 95 publications

(80 citation statements)

References 56 publications

(59 reference statements)

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“…There is an obvious interest in further investigating whether BP lowering by any of the major classes of antihypertensive therapy can be shown to be effective in reducing all or part of cardiovascular outcomes. Several meta-analyses have approached this problem in the past, [16][17][18][19][20][98][99][100][101][102][103][104][105][106] but none of them has been comprehensive of all BP-lowering RCTs from 1966 to the end of 2013 and simultaneously exclusive of RCTs comparing different active regimens (the latter type of trials aim at avoiding, instead of inducing, a between-group BP difference) and of RCTs investigating antihypertensive drugs in the treatment of conditions different from hypertension (such as myocardial infarction and HF). Figure 3A).…”

Section: Effects Of Bp Lowering Produced By Drugs Belonging To Differmentioning

confidence: 99%

Randomized Controlled Trials of Blood Pressure Lowering in Hypertension

Zanchetti

Thomopoulos

Parati

2015

Circulation Research

146

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Sixty-eight blood pressure (BP)-lowering randomized controlled trials (defined as randomized controlled trials comparing active treatment with placebo, or less active treatment, achieving a BP difference, performed between 1966 and end 2013 in cohorts with ≥40% hypertensive patients, and exclusive of trials in acute myocardial infarction, heart failure, acute stroke, and dialysis) were identified and meta-analyzed grouping the randomized controlled trials on the basis of clinically relevant questions: (1) does BP lowering reduce all types of cardiovascular outcome? (2) Is prevention of all outcomes proportional to the extent of systolic, diastolic, and pulse BP? (3) Have all classes of BP-lowering drugs been shown capable of reducing all types of cardiovascular outcome? (4) Is BP lowering beneficial when intervention is initiated at any grade (or stage) of hypertension? (5) Do BP-lowering randomized controlled trials provide evidence about systolic BP and diastolic BP targets of treatment? (6) Should BP-lowering treatment be preferentially addressed to patients in higher risk categories promising larger absolute treatment benefits? The results of these meta-analyses provide further support to current hypertension treatment guidelines by showing that BP lowering can significantly reduce major cardiovascular outcomes largely independent of the agents used, significant risk reduction is found at all hypertension grades (stages), and when systolic BP is lowered below a cut off of 140 mm Hg with some further reduction limited to stroke at systolic BP values just <130 mm Hg. Absolute risk reduction progressively increases higher is total cardiovascular risk, but this greater benefit is associated with a progressively higher residual risk, ie, higher treatment failures. (Circ Res.

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Section: Effects Of Bp Lowering Produced By Drugs Belonging To Differmentioning

confidence: 99%

Randomized Controlled Trials of Blood Pressure Lowering in Hypertension

Zanchetti

Thomopoulos

Parati

2015

Circulation Research

146

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“…The study was designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement [20,21]. The MEDLINE, Cochrane database, ISI Web of Science and SCOPUS database were searched for articles published in all languages until November 2011.…”

Section: Data Sources and Searchesmentioning

confidence: 99%

Haemodynamics, exercise capacity and clinical events in pulmonary arterial hypertension

et al. 2012

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The purpose of this study was to clarify whether changes in cardiopulmonary haemodynamics induced by pharmacological therapy correlate with exercise capacity and clinical events in patients with pulmonary arterial hypertension.16 randomised trials including 2353 patients, followed up for 16.4¡10.6 weeks, measuring cardiopulmonary haemodynamics by right heart catheterisation and reporting clinical events were included. Meta-analysis and meta-regression analysis were performed to assess the effects of treatments on clinical events and the relationship between haemodynamic changes (pulmonary artery pressure, pulmonary vascular resistance, cardiac index and right atrial pressure) and clinical events.Treatments significantly reduced all-cause death (OR 0.5, 95% CI 0.3-0.7; p,0.01), hospitalisation for pulmonary arterial hypertension (OR 0.4, 95% CI 0.2-0.7; p,0.01), initiation of rescue therapy (OR 0.3, 95% CI 0.2-0.6; p,0.01) and the composite outcome (OR 0.3, 95% CI 0.3-0.5; p,0.01). No relationship was found between changes of haemodynamic parameters and clinical events, whereas changes of cardiac index and pulmonary vascular resistance significantly correlated with changes in the 6-min walking distance (r50. 64, p50.03; r5 -0.55, p50.04, respectively).In patients with pulmonary arterial hypertension, improvements of cardiopulmonary haemodynamics observed in randomised clinical trials correlate with exercise capacity changes but do not predict clinical events in a short-term follow-up. @ERSpublications In PAH, cardiopulmonary haemodynamic improvements correlate with exercise capacity changes but not with clinical events

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“…В когортных исследованиях было проанализировано большое число рандомизи-рованных исследований антигипертензивной тера-пии и сделан вывод, что основные преимущества антигипертензивной терапии обусловлены сниже-нием АД как такового и в основном не зависят от того, какие именно препараты для этого назначаются. Хотя время от времени появляются мета-анализы, в которых утверждается превосходство одного класса препаратов перед другим по ряду конечных точек [391][392][393], это зависит преимущественно от смещен-ного выбора исследований для анализа. Самые круп-ные из существующих мета-анализов показывают отсутствие клинически значимых различий между разными классами препаратов [284,394,395].…”

Section: регулярные физические нагрузкиunclassified

2013 Esh/Esc Guidelines for the Management of Arterial Hypertension

Mancia

Fagard²,

Redón³

et al. 2014

Russ J Cardiol

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Авторы/члены рабочей группы: Giuseppe Mancia (сопредседатель; италия)*, Robert Fagard (сопредседатель; бельгия)*, Krzysztof Narkiewicz (координатор секции, Польша), Josep Redón (координатор секции; испания), Alberto Zanchetti (координатор секции, италия), Michael Böhm

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Calcium channel blockers and cardiovascular outcomes: a meta-analysis of 175 634 patients

Cited by 95 publications

References 56 publications

Randomized Controlled Trials of Blood Pressure Lowering in Hypertension

Randomized Controlled Trials of Blood Pressure Lowering in Hypertension

Haemodynamics, exercise capacity and clinical events in pulmonary arterial hypertension

2013 Esh/Esc Guidelines for the Management of Arterial Hypertension

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