Effect of Amlodipine in Stroke and Myocardial infarction: A Systematic Review and Meta-analysis

Abstract

Introduction: Hypertension is a progressive cardiovascular condition arising from complex aetiologies. Progression is strongly associated with functional and structural abnormalities that lead to multi-organ dysfunction. Stroke and myocardial infarction are two of the major complications of hypertension in India. Various anti-hypertensive drugs, such as calcium channel blockers (CCBs), beta-blockers, diuretics, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have been the medications of choice for disease management and are known to be effective in reducing the complications of hypertension. CCBs, such as amlodipine, are also currently being used and proven to be effective, although their beneficial effects in the management of complications of hypertension like stroke and myocardial infarction (MI) have yet to be proven. Therefore, the aim of this systematic review was to evaluate the effect of amlodipine on stroke and MI in hypertensive patients. Methods: A systematic search of English electronic databases was performed for studies with sufficient statistical power that were published between 2000 andl 30 August 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. A total of 676 papers were screened, and 13 were found eligible to be included in the meta-analysis. Studies that included patients who suffered from MI or stroke and were under amlodipine treatment were included in the analysis. The odds ratio and the risk ratio of amlodipine compared to active control/placebo were noted from the studies and statistically analyzed. Results: Amlodipine had a significant effect in reducing stroke and MI in hypertensive patients. Similar to results published in reports, this systematic review proved that the hazard ratio for amlodipine was \ 1 for stroke (0.69-1.04) and MI (0.77-0.98), showing that amlodipine accounted for better prevention of stroke and MI. Conclusion:In the pooled analysis of data from 12 randomised controlled trials and one double-

Blood Pressure Control and Prescription Pattern of Antihypertensive Drugs in Adherence to the 2020 International Society of Hypertension (ISH) Global Hypertension Practice Guidelines in Saudi Arabia: A Retrospective Study

“…However, few studies have demonstrated that RAS blockers are less effective than TZD/TZD-like diuretics and DHP-CCBs in lowering BP and preventing stroke [22,23]. DHP-CCBs are a good choice for initial therapy when TZD diuretics are not tolerated [22,23]. In our study, the most preferred choice among stroke patients were RAS blockers (92.3%) and DHP-CCBs (69.2%).…”

“…The treatment guidelines recommended RAS blockers, DHP-CCBs, and TZD diuretics as first-line antihypertensive agents to prevent recurrent strokes [9]. However, few studies have demonstrated that RAS blockers are less effective than TZD/TZD-like diuretics and DHP-CCBs in lowering BP and preventing stroke [22,23]. DHP-CCBs are a good choice for initial therapy when TZD diuretics are not tolerated [22,23].…”

Amlodipine in the current management of hypertension

“…46 Based on a recent meta-analysis that included 13 studies and more than 50 000 patients, amlodipine reduced the incidence of MI (13%) when compared to other antihypertensive drugs. 47 Several mechanisms have been proposed to explain the benefits of CCBs/amlodipine on stroke protection: (1) Amlodipine has a longer duration of action than almost all other antihypertensive drugs 21 ;…”

“…Amlodipine also showed better protection against stroke (16%) and myocardial infarction (MI, 17%) when compared with ARBs in a quantitative overview 46 . Based on a recent meta‐analysis that included 13 studies and more than 50 000 patients, amlodipine reduced the incidence of MI (13%) when compared to other antihypertensive drugs 47 …”

Pharmacokinetic Drug Interaction Between Amlodipine and Tadalafil: An Open-Label, Randomized, Multiple-Dose Crossover Study in Healthy Male Volunteers

“…Amlodipine is one of the most extensively used oral dihydropyridine calcium channel blocker (CCB), which particularly reduced blood pressure variability and was effective for protecting stroke and myocardial infarction. 6 It is slowly absorbed with T max of 5.0–6.0 h after oral administration and is eliminated via a biphasic mode with a half-life of 40–60 h. 7 In terms of metabolism, it is known as a substrate and a weak inhibitor of CYP3A4. 8 , 9 …”