Rimoldi SF et al. J Clin Hypertens (Greenwich). 2015;17(3):193-199.

Efficacy and safety of calcium channel blocker/diuretics combination therapyin hypertensive patients: a meta-analysis

Methods

Four studies (ELSA, VALUE, FEVER, COPE) with a total of 30 791 patients fulfilled the inclusion criteria and were included.

Random-effects meta-analysis comparing ischemic outcomes between patients treated with a CCB/thiazide diuretic combination and those treated with other antihypertensive medications at maximum available follow up.

Characteristics of the studiesincluded in the analysis

ELSA VALUE FEVER COPE

Number of randomized patients 2334 15 245 9711 3501

Active treatment CCB/DIU CCB/DIU CCB/DIU CCB/DIU

Comparator βB/DIU ARB/DIU DIU CCB/ARBor CCB/βB

BP at entry (mmHg) 164/101 vs 163/101 155/88 vs 154/87 154/91 vs 154/91 154/89 vs 154/89 and 154/89

Drop in SBP (mmHg) 21.6 vs 21.8 17.3 vs 15.2 16.9 vs 11.9 20.0 vs

19.3 and 20.1

Drop in DBP (mmHg) 15.5 vs 15.6 9.9 vs 8.2 8.5 vs 6.3 12.4 vs

11.8 and 12.0

Results

The combination of a CCB with a thiazide (-like) diuretic exhibited similar risks of all cause mortality (RR, 0.89; 95% CI, 0.75-1.06) and cardiovascular mortality (RR, 0.89; CI, 0.71-1.10) compared with other hypertensive medications.

Moreover, the combination CCB/ thiazide (-like) diuretic was associated with a significant risk reduction for MI (RR, 0.83; CI, 0.73-0.95) and stroke (RR, 0.77; CI, 0.64-0.92) compared with other hypertensive medications.

Thiazide diuretics/calcium channel blockers:more effective than other combinations in reducing stroke

CCB, calcium channel blocker; CI, confidence internval; DIU, diuretic.

Conclusions

• Calcium channel blocker/diuretic combination therapy is safe and efficient in reducing morbidity and mortality in hypertension.

• Calcium channel blocker/diuretic combination therapy may be particularly useful to reduce systolic blood pressure and to confer cerebrovascular protection.