Table 4. Meta-analyses of Comparisons of Antihypertensive Drugs
| Study Description |
Comparisons |
Comments |
Study
(Population)
(Quality) |
Inclusion
Criteria |
Number of
Studies |
Calcium Antagonists
vs |
ACE Inhibitors
vs |
Calcium Antagonists
vs |
Blood Pressure Trialists, 2000 (72)
(diabetics and nondiabetics)
(good) |
Random assignment of patients between anti-hypertensive regimens
Minimum of 1000 p-years in each group
Prespecified outcomes |
8 |
D/beta
CHD 1.121 (1.00 - 1.26) |
D/beta
No difference for any outcome |
ACEI
1.231 (1.03 - 1.47) |
Heterogeneity in trials comparing CA and ACEI |
| Stroke 0.87 (0.77 - 0.98) |
0.98 (0.83 - 1.18) |
| CHF 1.12 (0.95 - 1.33) |
1.22 (1.00 - 1.49) |
| CVD events 1.02 (0.95 - 1.10) |
1.09 (0.99 - 1.20) |
| Mortality 1.01 (0.92 - 1.11) |
0.97 (0.85 - 1.10) |
Pahor et al., 2000 (73)
(diabetics and nondiabetics)
(good) |
Patients with hypertension; compared CA with another drug;
assessed CVD events; included 100 people or more |
9 |
All other drugs, all participants
MI 1.262 (1.11 - 1.43) |
CA, all participants
1.432 (1.15 - 1.76) |
All other drugs, diabetics
1.532 (1.01 - 2.31) |
Diabetics qualitatively same as all participants, but with higher ORs |
| Stroke 0.90 (0.80 - 1.02) |
1.01 (0.84 - 1.23) |
1.37 (0.86 - 2.20) |
| CHF 1.25 (1.07 - 1.46) |
1.24 (1.00 - 1.55) |
1.76 (0.97 - 3.21) |
| CVD events 1.10 (1.02 - 1.18) |
1.18 (1.04 - 1.33) |
1.44 (1.09 - 1.91) |
| Mortality 1.03 (0.94 - 1.13) |
0.97 (0.83 - 1.13) |
1.24 (0.84 - 1.83) |
Pahor et al., 2000 (65)
(diabetics only)
(good) |
RCT of ACE inhibitor vs other drug for hypertensive diabetics;
≥2 years followup; CVD outcomes |
4
ABCD
CAPPP
FACET
UKPDS
(heterogeneity) |
NA |
D/beta or CA
MI 0.373 (0.24 - 0.57) |
NA |
Heterogeneity when UKPDS added in; results are for other 3 trials without
UKPDS |
| Stroke 0.76(0.48 - 1.22) |
| CVD events 0.49 (0.36 - 0.67) |
| Mortality 0.57(0.38 - 0.87) |
1 RR (95% CI); values <1 favors calcium antagonists
2 OR (95% CI); OR <1.0 favors calcium antagonists
3 RR (95% CI); RR <1.0 favors ACE inhibitor
Notes: p-years = person - years; first column compares calcium antagonists with diuretic/Bblockers, D/beta = diuretics and/or Bblockers, ACEI = angiotensin converting enzyme inhibitor, CA = calcium antagonists.
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