Long-term Safety of Calcium-Channel Blockers

Posted by e-Medical PPT Tuesday, October 9, 2012
Calcium-Channel Blockers Controversy
Reports of adverse outcome started in 1991
Increased risk of myocardial infarction
higher total mortality
association with cancer
association with GI bleeding

WHO-ISH:World Health Organization International Society of Hypertension
“Effects of calcium antagonist on the risks of coronary heart disease, cancer , and bleeding” Due to the limitation and inconsistency of the available evidence … the risks of CAD, cancer, and bleeding remains unproven.   

Meta-analysis on calcium-channel blockers
31 trials on short-acting CCB 16 trials in which only nifedipine was used
short-acting nifedipine probably increases the risk of reinfarction or death, in a dose-dependent way
non-dihydropyridines do not increase mortality and may reduce reinfarction

CCB in Heart Failure
Prospective Randomized Amlodipine Survival Evaluation Study
Background Calcium-channel blockers increase mobidity and mortality in patients with chronic heart failure. Eval the effect of amlodipine in severe CHF.
Methods 1153 pts with severe CHF, EF <30%, randomized to receive amlodipine (n=571) or placebo (n=582) for 6-33 months, while receiving usual therapy
Primary end point All-cause mortality and hospitalization for major cardiovascular events

Amlodipine did not increase cardiovascular morbidity and mortality
May be used relatively safely in patients with combined angina, HTN, and severe heart failure
Reduction in mortality in patient with nonischemic cardiomyopathy requires confirmation by the ongoing PRAISE-2 trial.

Vasodilator-Heart Failure Trial
Diuretics and ß-blockers remain the preferred therapy for treating patients with HTN - based on reduction in morbidity and mortality
ß-blockers and/or nitrates are the preferred treatment for patients with angina
ACE inhibitors are preferred for the treatment of HTN in patients with diabetes + proteinuria
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