Calcium channel blockers versus other classes of drugs for hypertension

First-line CCBs may not be significantly different from any of the other classes of antihypertensive drugs for total mortality. First-line CCBs may have a harmful effect on the outcome of congestive heart failure.

A Cochrane review included 18 studies (14 dihydropyridines, 4 non-dihydropyridines) with a total of 141 807 subjects. All-cause mortality was not different between first-line calcium channel blockers (CCBs) and any other first-line antihypertensive classes: diuretics (RR 0.98, 95% CI 0.92 to 1.04; 5 studies, n=35 057); β-blockers (RR 0.94, 95% CI 0.88 to 1.00; 4 studies, n= 44 825); diuretics and β-blockers (RR 1.03, 95% CI 0.94 to 1.12; 3 studies, n=31 892); ACE inhibitors (RR 0.96, 95% CI 0.91 to 1.03; 5 studies, n=24 006); and ARBs (RR 0.98, 95% CI 0.90 to 1.07, 2 studies, n= 16 391). CCBs reduced the following outcomes as compared to β-blockers: total cardiovascular events (RR 0.84, 95% CI 0.77 to 0.92), stroke (RR 0.77, 95% CI 0.67 to 0.88) and cardiovascular mortality (RR 0.90, 95% CI 0.81 to 0.99, statistical heterogeneity, I²=62%). CCBs increased total cardiovascular events (RR 1.05, 95% CI 1.00 to 1.09, p = 0.03) and congestive heart failure events (RR 1.37, 95% CI 1.25 to 1.51) as compared to diuretics. CCBs reduced stroke (RR 0.89, 95% CI 0.80 to 0.98) as compared to ACE inhibitors and reduced stroke (RR 0.85, 95% CI 0.73 to 0.99, statistical heteroheneity, I²=53%) and MI (RR 0.83, 95% CI 0.72 to 0.96) as compared to ARBs. CCBs also increased congestive heart failure events as compared to ACE inhibitors (RR 1.16, 95% CI 1.06 to 1.27) and ARBs (RR 1.20, 95% CI 1.06 to 1.36, statistical heterogeneity, I²=73%). The other evaluated outcomes were not significantly different.

Comment: The quality of evidence is downgraded by indirectness (differences in studied interventions) and by inconsistency (heterogeneity in interventions and outcomes).

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1. Chen N, Zhou M, Yang M, Guo J, Zhu C, Yang J, Wang Y, Yang X, He L. Calcium channel blockers versus other classes of drugs for hypertension. Cochrane Database Syst Rev 2010;(8):CD003654.