Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Can J Cardiol. 2017 May;33(5):635-643. doi: 10.1016/j.cjca.2017.01.011. Epub 2017 Jan 21.
Whether calcium channel blockers exert a greater effect on cardiovascular risk reduction in Asian populations than other antihypertensive agents is unclear. We conducted a meta-analysis of hypertension trials of dihydropyridine calcium channel blockers in Asian populations to clarify this association.
EMBASE, MEDLINE, and Cochrane databases were searched (from inception to August 2016) for randomized controlled trials on cardiovascular death, major adverse cardiovascular events, stroke, congestive heart failure, and coronary revascularization in Asian persons with hypertension. We identified 9 trials that reported data specific to Asian populations (N = 29,643). These trials included 1 placebo-controlled trial and 8 active comparator trials; of these, 5 had angiotensin receptor blockers as the active comparator.
One placebo-controlled trial (n = 9711) showed significantly reduced cardiovascular mortality, major adverse cardiovascular events, and stroke with calcium channel blockers. Among 8 active comparator trials (n = 19,932), there were no significant differences in mortality (relative risk [RR], 1.10; 95% confidence interval [CI], 0.72-1.67; I = 0.0%), major adverse cardiovascular events (RR, 1.02; 95% CI, 0.90-1.15; I = 0.0%), stroke (RR, 0.97; 95% CI, 0.80-1.17; I = 0.0%), congestive heart failure (RR, 1.01; 95% CI, 0.51-2.00; I = 53.7), or coronary revascularization rates (RR, 0.98; 95% CI, 0.76-1.25; I = 0.0%) in the calcium channel blocker group compared with other antihypertensive agents. When restricting the meta-analysis to angiotensin receptor blocker comparators (n = 10,384), there were no significant differences in cardiovascular outcomes.
There is no evidence that dihydropyridine calcium channel blockers are superior to other antihypertensive agents in Asian populations for the treatment of hypertension.
钙通道阻滞剂（calcium channel blockers，CCBs）在亚洲人群中降低心血管风险的效果是否优于其他降压药物尚不清楚。我们进行了一项荟萃分析，以明确亚洲人群中二氢吡啶类 CCB 类降压药物与心血管死亡、主要不良心血管事件、卒中等之间的关系。
检索 EMBASE、MEDLINE 和 Cochrane 数据库（从建库至 2016 年 8 月），纳入亚洲高血压人群中有关心血管死亡、主要不良心血管事件、卒中等的随机对照试验。共纳入 9 项仅针对亚洲人群的试验（N=29643），其中 1 项为安慰剂对照试验，8 项为阳性药物对照试验，5 项阳性药物对照试验的对照药物为血管紧张素受体阻滞剂。
1 项安慰剂对照试验（n=9711）结果显示，CCBs 可显著降低心血管死亡率、主要不良心血管事件和卒中等风险。8 项阳性药物对照试验（n=19932）结果显示，CCBs 与其他降压药物相比，死亡率（RR=1.10，95%CI：0.72-1.67；I²=0.0%）、主要不良心血管事件（RR=1.02，95%CI：0.90-1.15；I²=0.0%）、卒中等（RR=0.97，95%CI：0.80-1.17；I²=53.7%）、充血性心力衰竭（RR=1.01，95%CI：0.51-2.00；I²=53.7%）和血运重建率（RR=0.98，95%CI：0.76-1.25；I²=0.0%）无显著差异。将荟萃分析限制在血管紧张素受体阻滞剂（angiotensin receptor blockers，ARB）对照试验（n=10384）中时，心血管结局也无显著差异。
在亚洲人群中，与其他降压药物相比，二氢吡啶类 CCB 类药物在治疗高血压方面并未显示出优势。
