Critical appraisal of recent studies on nifedipine and other calcium channel blockers in coronary artery disease and hypertension

Tijssen, Jan G.P.; Hugenholtz, Paul G.

doi:10.1093/oxfordjournals.eurheartj.a015031

Cited by 18 publications

(7 citation statements)

References 10 publications

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“…Although concern about potential confounding is both important and appropriate, approaches to detecting and controlling confounding are available, and, indeed, there are mathematical limits to what unmeasured or unknown confounding can explain. As Walker and Stampfer suggest, 9 confounding represents “an alternative storyline.” Given the data and the analysis presented, readers need to assess seriously the plausibility of the alternative storylines 11 …”

Section: Concluding Observationsmentioning

confidence: 99%

“…In the example of the association between myocardial infarction and the use of calcium channel blockers among hypertensive patients, 10 the argument runs as follows: calcium channel blockers are used to treat angina pectoris as well as hypertension; angina pectoris is a major risk factor for myocardial infarction; because the use of calcium channel blockers is simply a marker for high‐risk angina patients, the association between the use of calcium channel blockers and the incidence of myocardial infarction is, therefore, not a causal one. This argument, offered by a number of commentators, 11–14 describes perfectly the problem of confounding by indication. The purpose of this article is to describe several analytic approaches that make it possible in some observational studies of medication effects to detect and control for confounding by indication.…”

mentioning

confidence: 97%

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Assessment and Control for Confounding by Indication in Observational Studies

Psaty

Koepsell

Lin

et al. 1999

J American Geriatrics Society

297

227

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In the evaluation of pharmacologic therapies, the controlled clinical trial is the preferred design. When clinical trial results are not available, the alternative designs are observational epidemiologic studies. A traditional concern about the validity of findings from epidemiologic studies is the possibility of bias from uncontrolled confounding. In studies of pharmacologic therapies, confounding by indication may arise when a drug treatment serves as a marker for a clinical characteristic or medical condition that triggers the use of the treatment and that, at the same time, increases the risk of the outcome under study. Confounding by indication is not conceptually different from confounding by other factors, and the approaches to detect and control for confounding--matching, stratification, restriction, and multivariate adjustment--are the same. Even after adjustment for known risk factors, residual confounding may occur because of measurement error or unmeasured or unknown risk factors. Although residual confounding is difficult to exclude in observational studies, there are limits to what this "unknown" confounding can explain. The degree of confounding depends on the prevalence of the putative confounding factor, the level of its association with the disease, and the level of its association with the exposure. For example, a confounding factor with a prevalence of 20% would have to increase the relative odds of both outcome and exposure by factors of 4 to 5 before the relative risk of 1.57 would be reduced to 1.00. Observational studies have provided important scientific evidence about the risks associated with several risk factors, including drug therapies, and they are often the only option for assessing safety. Understanding the methods to detect and control for confounding makes it possible to assess the plausibility of claims that confounding is an alternative explanation for the findings of particular studies.

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Section: Concluding Observationsmentioning

confidence: 99%

mentioning

confidence: 97%

Assessment and Control for Confounding by Indication in Observational Studies

Psaty

Koepsell

Lin

et al. 1999

J American Geriatrics Society

297

227

View full text Add to dashboard Cite

show abstract

“…Вместе с тем, некоторые авторы отмечали ограниче-ния в мета-анализе Furberg C.D., которые могли привести и к другим выводам [7,8].…”

Section: нифедипин в современной кардиологииunclassified

Dihydropyridine Calcium Antagonists. Position of Nifedipine in Modern Cardiology Practice

Garganeeva

2011

Racionalʹnaâ farmakoterapiâ v kardiologii

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Научно-исследовательский институт кардиологии Сибирского отделения Российской академии медицинских наук. 634012, Томск, ул. Киевская, 111-А Дигидропиридиновые антагонисты кальция. Место нифедипина в современной кардиологической практике А.А. Гарганеева* Научно-исследовательский институт кардиологии Сибирского отделения Российской академии медицинских наук. 634012, Томск, ул. Киевская, 111-А Освещается место нифедипина в современной кардиологической практике. Рассматривается применение нифедипина для лечения артериальной гипертонии, в том числе в со-ставе комбинированной антигипертензивной терапии, профилактики инсультов, при гипертоническом кризе, ишемической болезни сердца. Приводятся преимущества исполь-зования современных лекарственных форм нифедипина. Отдельно рассматриваются возможности применения нифедипина при легочной гипертензии, а также во время бере-менности. Ключевые слова: антагонисты кальция, нифедипин, артериальная гипертония, ишемическая болезнь сердца. Position of nifedipine in modern cardiology practice is highlighted. Nifedipine usage for arterial hypertension therapy, including combined one, stroke prevention, treatment of hypertensive crisis and ischemic heart disease is considered. Advantages of nifedipine innovative formulations are presented. Possible usage of nifedipine in pulmonary hypertension as well as pregnancy is discussed specially.

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“…Although immediate release formulations of CCBs were approved only for treatment of vasospastic angina, they were prescribed historically to many patients as an anti-hypertensive as well. Further evaluation of these meta-analyses and case control study highlight many limitations including indication bias in the case-control study, as well as multiple inaccuracies in the Furberg analysis, which may lead to a different conclusion altogether 27,28. At present, there is no indication for short-acting CCB therapy.…”

mentioning

confidence: 99%

Review of nifedipine GITS in the treatment of high risk patients with coronary artery disease and hypertension

Lundy

Lutfi²,

Beckey³

2009

VHRM

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Nifedipine is a dihydropyridine calcium-channel blocker (CCB) introduced approximately 30 years ago for the prophylaxis of angina symptoms, and then later utilized as an anti-hypertensive agent. In the 1990s, several meta-analyses and a case-control study were published which raised concern regarding increased mortality and increased risk for myocardial infarction with short-acting nifedipine. Further evaluation of these meta-analyses and case control study underscores some important limitations and the need to further elucidate the role of this class of medications in high-risk patients. Until 2000, there was a paucity of data on the long-term effects as well as the long-term outcomes of CCBs in the treatment of stable coronary disease or in patients with manifestations of the disease such as hypertension or angina. While it has been well established that nifedipine and other dihydropyridines lower blood pressure and improve symptoms of angina, several studies were designed to evaluate the effect of dihydropyridines on “hard” outcomes, specifically cardiovascular and cerebrovascular events. In this review, we describe the clinical studies evaluating the use of nifedipine when compared to placebo as well as other anti-hypertensive therapies in an attempt to identify the most appropriate place in therapy for this class of medications and to further clarify its utilization in high-risk patients.

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Critical appraisal of recent studies on nifedipine and other calcium channel blockers in coronary artery disease and hypertension

Cited by 18 publications

References 10 publications

Assessment and Control for Confounding by Indication in Observational Studies

Assessment and Control for Confounding by Indication in Observational Studies

Dihydropyridine Calcium Antagonists. Position of Nifedipine in Modern Cardiology Practice

Review of nifedipine GITS in the treatment of high risk patients with coronary artery disease and hypertension

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