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