Efficacy and Safety of Dihydropyridine Calcium Channel Blockers for Primary Hypertension: A Bayesian Network Meta-analysis.

IF 0.8 Q3 PERIPHERAL VASCULAR DISEASE Current Hypertension Reviews Pub Date : 2025-01-01 DOI:10.2174/0115734021357729250214090452

Huiduo Wang, Hongxin Yang, Zhiyong Zhang, Hao Guo

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Abstract

Introduction: Dihydropyridine-calcium channel blockers (DHP-CCBs) are effective first-line blood pressure-lowering agents for primary hypertension. However, data comparing the variations in efficacy and safety between different types of DHP-CCBs are scarce.

Aims and objectives: This study aimed to summarize the latest evidence on the benefits and harms of seven DHP-CCBs (amlodipine, levamlodipine, felodipine, lacidipine, nitrendipine, nifedipine, and benidipine).

Methods: A meta-analysis of DHP-CCBs was carried out to explore differences in efficacy and safety. We searched PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and VIP databases from inception to September, 2023, for randomized controlled trials (RCTs) comparing DHP-CCBs. The main outcomes were blood pressure lowering and adverse events (AEs) during treatment.

Results: We included 181 RCTs (21,383 patients) in this analysis. In terms of efficacy, levamlodipine ranked highest in reducing office blood pressure (surface under the cumulative ranking systolic blood pressure = 80.81%, diastolic blood pressure (DBP) = 82.42%) and 24-h ambulatory DBP (98.07%). Felodipine had the highest probability of reducing 24-h ambulatory blood pressure (80.65%). Regarding safety, levamlodipine had the least impact on heart rate (85.71%). In terms of AEs, benidipine had the highest rate for cardiovascular (86.58%) and digestive system (93.57%) AEs. Nifedipine and amlodipine had the highest rates of central (80.65%) and peripheral nervous system (83.28%) AEs, respectively. Levamlodipine exhibited significantly lower rates of total AEs (1.24%), central nervous system AEs (1.28%), and cardiovascular system AEs (3.62%) than the other interventions.

Conclusion: In the office setting, levamlodipine may be the best treatment for primary hypertension, and lacidipine shows good safety.

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二氢吡啶钙通道阻滞剂治疗原发性高血压的疗效和安全性：一项贝叶斯网络meta分析。

背景：二氢吡啶-钙通道阻滞剂（DHP-CCBs）是治疗原发性高血压的有效一线降压药。然而，比较不同类型DHP-CCBs之间疗效和安全性差异的数据很少。目的和目的：本研究旨在总结7种DHP-CCBs（氨氯地平、左旋氨氯地平、非洛地平、拉西地平、尼群地平、硝苯地平和苯尼地平）的益处和危害的最新证据。方法：对DHP-CCBs进行meta分析，探讨其疗效和安全性的差异。我们检索了PubMed、Embase、Cochrane Library、中国知网、万方数据和VIP数据库，检索了自成立至2023年9月间比较DHP-CCBs的随机对照试验（RCTs）。主要结局是治疗期间血压降低和不良事件（ae）。结果：我们纳入了181项随机对照试验（21,383例患者）。在降压效果方面，左旋氨氯地平在降低办公室血压（表面下累积排名收缩压= 80.81%，舒张压[DBP] = 82.42%）和24小时动态舒张压（98.07%）方面排名最高。非洛地平降低24小时动态血压的概率最高（80.65%）。安全性方面，左旋氨氯地平对心率影响最小（85.71%）。在ae方面，苯尼地平对心血管（86.58%）和消化系统（93.57%）的ae发生率最高。硝苯地平和氨氯地平的中枢和周围神经系统ae发生率最高，分别为80.65%和83.28%。左旋氨氯地平的总不良事件发生率（1.24%）、中枢神经系统不良事件发生率（1.28%）和心血管系统不良事件发生率（3.62%）明显低于其他干预措施。结论：在办公室环境下，左旋氨氯地平可能是原发性高血压的最佳治疗方法，拉西地平具有良好的安全性。

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来源期刊

Current Hypertension Reviews PERIPHERAL VASCULAR DISEASE-

CiteScore

4.80

自引率

0.00%

发文量

期刊介绍： Current Hypertension Reviews publishes frontier reviews/ mini-reviews, original research articles and guest edited thematic issues on all the latest advances on hypertension and its related areas e.g. nephrology, clinical care, and therapy. The journal’s aim is to publish the highest quality review articles dedicated to clinical research in the field. The journal is essential reading for all clinicians and researchers in the field of hypertension.