Abstract P480: Effects Of Long And Intermediate Acting Dihydropyridine Calcium Channel Blockers In Hypertension: A Systematic Review And Aeta-analysis Of 18 Prospective, Actively Controlled, Randomized Clinical Trials
Bibliographic record
Abstract
Background: Dihydropyridine calcium channel blockers are a heterogeneous group of antihypertensive drugs. Long acting dihydropyridine agent Amlodipine is widely used for mono and combination therapy for hypertension in clinical practice, while intermediate acting dihydropyridine agents such as Felodipine, Nifedipine-GITS etc. have shown inconsistent results in randomized clinical trials (RCTs). Methods and Results: A meta-analysis of 18 prospective, actively controlled RCTs enrolling a total of 80,069 hypertensive patients followed for a mean of 51.7 months was performed. Amlodipine therapy was associated with 24% higher risk of heart failure (RR: 1.24, [95%CI: 1.04 to 1.48], p= 0.019) but 16% lower risk of stroke (RR: 0.84, [95%CI: 0.73 to 0.95], p=0.009) without statistically significant effect on acute myocardial infarction (AMI) (RR: 0.90, [95%CI: 0.78 to 1.03], p=0.128) or cardiovascular event (CVE) (RR: 0.99, [95%CI: 0.93 to 1.06], p=0.814). Intermediate acting dihydropyridine calcium channel blocker therapy was associated with 24% higher risk of heart failure (RR: 1.24, [95%CI: 1.07 to 1.44], p=0.005), 27% higher risk of AMI (RR: 1.27, [95%CI: 1.04 to 1.55], p=0.019), 14% higher risk of CVE (RR: 1.14, [95%CI: 1.01 to 1.29], p=0.034) without statistically significant effect against stroke (RR: 1.03, [95%CI: 0.87 to 1.21], p=0.580). Amlodipine showed higher risk of heart failure (RR: 1.20, [95%CI: 1.00 to 1.43], p=0.045) and lower risk of stroke (RR; 0.85, [95%CI: 0.75 to 0.96], p= 0.007) compared to Renin-angiotensin-system (RAS) blockers. Intermediate acting dihydropyridine calcium channel blocker showed higher risk of heart failure (RR: 1.31, [95%CI: 1.09 to 1.57], p=0.004) and AMI (RR: 1.46, [95%CI: 1.00 to 2.14], p=0.050) compared to RAS blockers. Multivariate meta-regression suggested that the effect size may differ between intermediate and long acting agents for stroke (B: -0.27, [95%CI: -0.50 to -0.05], p=0.012) and AMI (B: -0.42, [95%CI: -0.69 to -0.16], p=0.002) after adjustment for baseline presence of diabetes. Conclusions: This study suggests that Amlodipine offers greater protection against major complications of hypertension compared to intermediate acting dihydropyridine calcium channel blockers.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.026 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.019 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".