Furberg CD, Psaty BM, Meyer JV
Nifedipine: dose-related increase in mortality in
patients with coronary heart disease
Circulation
(Sep) vol 92:1326-1331, 1995
This is a dose-response meta-analysis of 16 randomized secondary-prevention
trials of nifedipine. A stratified analysis was used so that comparisons of
drug vs. placebo always involved pts within the same trial. Nifedipine
(short-acting formulation stipulated in 11 trials; formulation not stated in
the other 5 trials) was associated with an increase in total mortality (risk
ratio 1.16, 95% CI 1.01-1.33); this effect was related to dose, with an
almost 3-fold increase seen for daily doses of 80 mg. Concomitant treatment
with beta-blockers may decrease risk (based on other studies). Putative
mechanisms of nifedipine adverse outcome include proischemic effect,
negative
inotropic effect, marked hypotension, reflex sympathetic
activation, or proarrhythmic effects.
(Leehey)
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Summer 95 articles
H: Drug therapy :
Calcium channel blockers
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Outcomes