Effect of Amlodipine on Morbidity and Mortality in Severe Chronic Heart Failure

Abstract

Amlodipine did not increase cardiovascular morbidity or mortality in patients with severe heart failure. The possibility that amlodipine prolongs survival in patients with nonischemic dilated cardiomyopathy requires further study.

Insuficiência cardíaca

“…Os antagonistas de canais de cálcio de segunda geração, amlodipina, felodipina, por possuírem perfil diferente, parecem não piorar a IC, entretanto seus benefícios são questionados [41][42][43] . Nos estudos VHeFT III e PRAISE, felodipina e amlodipina não modificaram a mortalidade dos pacientes quando comparados a placebo, entretanto alguns apresentaram edema de membros inferiores.…”

The Appropriate Blood Pressure Control in Diabetes (ABCD) Trial

“…These results are similar to those found in other clinical trials published earlier. 7,8 These cardiovascular outcomes could not be explained by baseline lipid profiles, since they were significantly worse in the group randomised to enalapril vs nisoldipine nor could they be explained by differences in blood pressure control or glucose control between the two groups. Another factor that may have played a role is that a significantly higher number of patients were receiving a beta-blocker and/or diuretic in the group randomised to enalapril vs the ACE inhibitor.…”

“…5,6 (3) Lastly, in double-blind, placebo-controlled, secondary prevention trials of cardiovascular events, dihydropyridine CCAs failed to demonstrate a reduction in ischaemic coronary events in a population of patients with either heart failure or hypertension. 7,8 Conversely, dihydropyridine CCAs, when used in concert with ACE inhibitors, demonstrate a reduction in cardiovascular mortality among patients with heart failure from non-ischaemic causes. 8 Another possible exception to this apparent lack of benefit by dihydropyridine CCAs on cardiovascular event reduction, is the SYST-EUR Trial.…”

“…7,8 Conversely, dihydropyridine CCAs, when used in concert with ACE inhibitors, demonstrate a reduction in cardiovascular mortality among patients with heart failure from non-ischaemic causes. 8 Another possible exception to this apparent lack of benefit by dihydropyridine CCAs on cardiovascular event reduction, is the SYST-EUR Trial. This trial demonstrated reductions in cardiovascular events and mortality in a group of elderly patients without heart failure or renal disease randomised to a dihydropyridine CCA.…”

“…While it is clear that people with pre-existing renal disease, diabetes, and hypertension may not gain benefits from blood pressure reduction with dihydropyridine CCAs, this does not appear to be the case in healthier elderly patients with hypertension alone or with diabetes in the absence of renal insufficiency. 8,15 Likewise, other very large scale trials such as the ALLHAT Trial 16 and the Hypertension Optimal Treatment (HOT) Trial, 17 each with a dihydropyridine CCA arm, have not been stopped due to unusually high cardiovascular event rates.…”