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
H: Special problems : Outcomes