Messerli FH, Opie LH, Chambers R
Long-term study of calcium antagonists: Reassessment of the Furberg hypothesis
16th Scientific Meeting of the International Society of Hypertension
ISH Abstract Book (Jun) 16: 1996

This is a reassessment of the metaanalysis by Furberg et al. (Circulation, Sept. 1, 1995) which purported to find a dose-related increase in mortality with short-acting nifedipine in patients with acute myocardial infarction. The statistics were recalculated from the original data in two independent statistical centers. This reassessment aimed at correcting the several misquotation errors (e.g., dose, total number of patients) in the Furberg study. Because the Furberg meta-analysis (which was a metaanalysis on unstable angina) included a study dealing with stable coronary artery disease (INTACT) the data were recalculated with and without INTACT.

When the chi square p values were recalculated based on the data in the Furberg study, the p value was found to be 0.05 and not 0.01. Recalculation from the original data resulted in a p value of 0.19 with the INTACT patients included, and p=0.36 when the INTACT patients were excluded.

Comment: The data suggest that the meta-analysis of Furberg et al may be incorrect; there was no overall significant increase in mortality in the nifedipine group compared with the control group. Logistic regression analysis showed neither a group nor a dose relationship to mortality. Although the observed increase in mortality in the nifedipine group was not statistically significant, the common clinical contention that acute release nifedipine should not be used in acute myocardial infarction remains undisputed (Carmine Zoccali, M.D, Reggio Calabria, Italy).

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16th Scientific Meeting of the International Society of Hypertension
H: Drug therapy : Calcium channel blockers
H: Special problems : Outcomes