Document Detail


Prevention of stroke and myocardial infarction by amlodipine and Angiotensin receptor blockers: a quantitative overview.
MedLine Citation:
PMID:  17502490     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In the present quantitative overview of outcome trials, we investigated the efficacy of amlodipine or angiotensin receptor blockers in the prevention of stroke and myocardial infarction in patients with hypertension, coronary artery disease, or diabetic nephropathy. The analysis included 12 trials of 94 338 patients. The analysis of trials involving an amlodipine group showed that amlodipine provided more protection against stroke and myocardial infarction than other antihypertensive drugs, including angiotensin receptor blockers (-19%, P<0.0001 and -7%, P=0.03) and placebo (-37%, P=0.06 and -29%, P=0.04). The analysis of trials involving an angiotensin receptor blocker group showed contrasting results between trials versus amlodipine and trials versus other antihypertensive drugs for stroke (+19% versus -25%; P<0.0001) and myocardial infarction (+21% versus +1%; P=0.03). The results of 3 trials comparing an angiotensin receptor blocker with placebo were neutral (P> or =0.14). The within-trial between-group difference in achieved systolic pressure ranged from -1.1 to +4.7 mm Hg for trials involving an amlodipine group and from -2.8 to +4.0 mm Hg for trials involving an angiotensin receptor blocker group. The metaregression analysis correlating odds ratios with blood pressure differences showed a negative relationship (regression coefficients: -3% to -8%), which reached statistical significance (regression coefficient: -6%; P=0.01) for stroke in trials involving an amlodipine group. In conclusion, blood pressure differences largely accounted for cardiovascular outcome.
Authors:
Ji-Guang Wang; Yan Li; Stanley S Franklin; Michel Safar
Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't     Date:  2007-05-14
Journal Detail:
Title:  Hypertension     Volume:  50     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-06-21     Completed Date:  2007-07-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  181-8     Citation Subset:  IM    
Affiliation:
Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. jiguangwang@netscape.net
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MeSH Terms
Descriptor/Qualifier:
Aged
Amlodipine / therapeutic use*
Angiotensin II Type 1 Receptor Blockers / therapeutic use*
Antihypertensive Agents / therapeutic use*
Coronary Artery Disease / drug therapy*
Diabetic Nephropathies / drug therapy*
Female
Humans
Hypertension / drug therapy*
Male
Middle Aged
Myocardial Infarction / drug therapy*,  prevention & control*
Randomized Controlled Trials as Topic
Regression Analysis
Stroke / prevention & control*
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Antihypertensive Agents; 88150-42-9/Amlodipine
Comments/Corrections
Comment In:
Hypertension. 2007 Oct;50(4):e73; author reply e74   [PMID:  17724273 ]
Hypertension. 2007 Oct;50(4):e71; author reply e72   [PMID:  17679647 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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