EvidenceAlerts

Shetty S, Malik AH, Feringa H, et al. Meta-Analysis Evaluating Calcium Channel Blockers and the Risk of Peripheral Arterial Disease in Patients With Hypertension. Am J Cardiol. 2020 Mar 15;125(6):907-915. doi: 10.1016/j.amjcard.2019.12.026. Epub 2019 Dec 27. (Systematic review)
Abstract

Clinical studies have shown that calcium channel blockers (CCB) can mitigate the progression of atherosclerosis. Their role in the primary prevention of peripheral artery disease (PAD) is unclear. We conducted a meta-analysis of randomized control trials (RCT) to compare the impact of CCB on the incidence of PAD in patients with hypertension. A comprehensive review of the literature was performed in PubMed and Cochrane registry. Studies were included if they were RCT and had outcome data on PAD with a follow-up duration of at least 6 months. CCB formed the intervention group, whereas the control group was constituted by either placebo or active treatment with any of the other antihypertensive medications. A random-effects meta-analysis was performed, and we report odds ratio as a measure of treatment effect. Our search identified 934 trials, of which 7 RCTs with 71,971 patients fulfilled the inclusion criteria. The mean duration of follow-up was 3.8 years. In patients receiving CCB, PAD events occurred in 547 out of 27,502 patients (2%) compared with 1,263 out of 42,659 patients in the control group (3%). Based on the random-effect model, the odds for development of PAD in hypertensive patients treated with CCB compared with the control group was 0.70 (95% confidence interval of 0.58 to 0.86, p?=?0.0005). In conclusion, this meta-analysis of RCTs of hypertensive patients, we found that treatment with CCB was strongly associated with a decrease in the PAD compared with other antihypertensive agents or placebo.

Ratings
Discipline Area Score
Internal Medicine 6 / 7
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Cardiology 5 / 7
Comments from MORE raters

Family Medicine (FM)/General Practice (GP) rater

This is not a particularly strong meta-analysis from a methodological point of view. The control group is a very heterogeneous as it includes both patients not receiving antihypertensive treatment at all (placebo) as well as others receiving different antihypertensive drugs. For this reason, it is not possible to properly evaluate whether the size of the different incidence of PAD between the treatment and control group is due to CCB or just to an under-treatment of hypertension.

Internal Medicine rater

Calcium Channel Blockers are of course widely used to treat hypertension and in the prevention of Coronary artery disease. Patients with peripheral arterial disease are at risk of arterial obstruction and subsequent limb loss. This meta-analysis of RCTs shows a distinct effect on reducing this risk by delaying progression of intimal arterial disease in the lower extremities.
Comments from EvidenceAlerts subscribers

Dr. Rajeev Gupta (3/1/2020 2:56 PM)

Amlodipine is the commonest CCB for HTN. The reduction in PAD is an added bonus. Reduction in stroke is already documented (Olssen et al meta-analysis in Lancet 2002).

Dr. Thomas Baitz (2/23/2020 11:24 AM)

NNT of 100 in almost four years is clinically not very impressive even when statistical significance is noted due to large sample size.