Prevention of Stroke and Myocardial Infarction by Amlodipine and Angiotensin Receptor Blockers

Abstract

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 ≥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.