Dihydropyridines, a group of calcium channel blockers commonly prescribed to treat hypertension, have been the topic of some debate in recent months due to fears that they lead to damaged blood vessels or a heightened heart failure risk. Many of those conversations have specifically focused on amlodipine, a dihydropyridine that is consistently one of the most prescribed medications for hypertension in the United States.
According to a new analysis published in Function, however, limiting the use of amlodipine could potentially make a disastrous impact on patient outcomes.[1]
“Removal of amlodipine as a front-line therapy would most likely increase deaths from hypertension dramatically,” corresponding author Anant B. Parekh, DPhil, a researcher with the National Institute of Environmental Health Sciences, said in a prepared statement. “The study recommends that amlodipine remain a first-line treatment for high blood pressure.”
Parekh et al. authors performed a meta-analysis that included data from more than 160,000 patients who previously participated in one of 25 randomized clinical trials (RCTs). These RCTs all focused on the impact of treating hypertension with dihydropyridine compared to alternative medications or a placebo. The meta-analysis found that placebos were associated with a 28% higher risk of heart failure than dihydropyridines. Beta-blockers, meanwhile, were associated with a heart failure risk comparable to treatment with dihydropyridines. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) and diuretics, meanwhile, were linked to a lower risk of heart failure than dihydropyridines.
A separate analysis of real-world data from more than 63,000 patients, meanwhile, found that dihydropyridines were linked to a decreased risk of heart failure, ischemic heart disease and myocardial infarction after one year than ACE inhibitors, ARBs and beta-blockers.
“The difference between the real-world analyses and the meta-analysis of RCTs may reflect the population characteristics where the real-world analysis included patients who were on monotherapy and without pre-existing cardiovascular disease, thus representing a low-risk cohort,” the group explained in the study.
The authors also noted that amlodipine was linked to a key benefit over some other medications: a long half-life that means it only needs to be taken once per day. This increases patient compliance, they wrote, on top of its ability to control blood pressure.
One of the primary concerns clinicians had about amlodipine was that it was actually opening calcium channels in blood vessels, which can increase blood pressure. Parekh and colleagues explained, however, that the drug is actually mimicking this process instead of actually opening those channels.
Click here to read the full study in Function, a journal of the American Physiological Society.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.