Clinical Evidence of Ca2＋ Channel Blocker in Stroke Prevention_Chinese Journal of Evidence-Based Medicine

Authors：

WU Bo , HE Li

Neurology Department of West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Ca2＋ channel blocker; Stroke prevention; Clinical evidence

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We searched MEDLINE and The Cochrane Library to find high quality evidence aboutCa2＋ channel blocker in primary or secondary stroke prevention and summarized the avaliable evidence. The results show that in addition to the effect on hypertension, Ca2＋ channel blocker has antiartherosclerotic effect and can reduce the frequency rate of stroke. It has played an important role in primary stroke prevention. But concomitantly it can increase the risk of heart disease and as yet there is no evidence on secondary stroke prevention. Accordingly, Ca2＋ channel blockers should not be recommended as the first-fine medicine for stroke prevention.

Citation： WU Bo ,HE Li. Clinical Evidence of Ca2＋ Channel Blocker in Stroke Prevention. Chinese Journal of Evidence-Based Medicine, 2005, 05(10): 792-796. doi: Copy

1.	顾东风,吴锡桂,甘文奇,刘东海,宿少勇,段秀芳,黄广勇.中国成年人高血压的患病率、知晓率、治疗和控制状况[J].中华预防医学杂志,2003;37(2):84～89.
2.	Gu DF,Wu XG,Gan WQ,Liu DH,Shu SY,Duan XF,Huang GY.The morbidity rate,treatment and control[J].Chinese Journal of Phylaxiology,2003;37(2):84-89.
3.	Song YM,Sung J,Lawlor DA,Smith DG,Shin Y,Ebrahim S.Blood pressure,haemorrhagic stroke,and ischaemic stroke:the Korean national prospective occupational cohort study[J].BMJ,2004;328(7435):324-325.
4.	He J,Whelton PK.Elevated systolic blood pressure and risk of cardiovascular and renal disease:overview of evidence from observational epidemiologic studies and randomized controlled trials[J].Am Heart J,1999;138(3 Pt 2):211-219.
5.	Luscher TF,Cosentino F.The classification of calcium antagonists and their selection in the treatment of hypertension,A reappraisal[J].Drugs,1998;55(4):509-517.
6.	Asmar R,Benetos A,Ghodsi N,Meilhac B,Safar M.Regional arterial hemodynamics and carotid circulation in essential arterial hypertension.Effect of nitrendipine in patients over 40 years of age[J].Presse Medicale,1993;22(35):1770-1775.
7.	Zanchetti A,Bond MG,Hennig M,Neiss A,Mancia G,Dal Palu C,et al.European Lacidipine Study on Atherosclerosis investigators.Calcium antagonist lacidipine slows down progression of asymptomatic carotid atherosclerosis:principal results of the European Lacidipine Study on Atherosclerosis (ELSA),a randomized,double-blind,long-term trial[J].Circulation,2002;106(19):2422-2427.
8.	Simon A,Gariepy J,Moyse D,Levenson J.Differential effects of nifedipine and co-amilozide on the progression of early carotid wall changes[J].Circulation,2001;103(24):2949-2954.
9.	Neal B,MacMahon S,Chapman N.Blood Pressure Lowering Treatment Trialists Collaboration.Effects of ACE inhibitors,calcium antagonists,and other blood-pressure-lowering drugs:results of prospectively designed overviews of randomised trials.Blood Pressure Lowering Treatment Trialists’Collaboration[J].Lancet,2000;356(9246):1955-1964.
10.	Kaplan NM.Hypertension trials:1990 to 2000[J].Current Opinion in Nephrology & Hypertension,2001;10(4):501-505.
11.	Opie LH,Schall R.Evidence-based evaluation of calcium channel blockers for hypertension:equality of mortality and cardiovascular risk relative to conventional therapy[J].Journal of the American College of Cardiology,2002;39(2):315-322.
12.	Kloner RA,Vetrovec GW,Materson BJ,Levenstein M.Safety of long-acting dihydropyridine calcium channel blockers in hypertensive patients[J].American Journal of Cardiology,1998;81(2):163-169.
13.	Pahor M,Psaty BM,Alderman MH,Applegate WB,Williamson JD,Cavazzini C,Furberg CD.Health outcomes associated with calcium antagonists compared with other first-line antihypertensive therapies:a meta-analysis of randomised controlled trials[J].Lancet,2000;356(9246):1949-1954.
14.	Stason WB,Schmid CH,Niedzwiecki D,Whiting GW,Caubet JF,Luo D,Ross SD,Chalmers TC.Safety of nifedipine in patients with hypertension:a meta-analysis[J].Hypertension,1997;30(1 Pt 1):7-14.
15.	Black HR,Elliott WJ,Grandits G,Grambsch P,Lucente T,White WB.CONVINCE Research Group.Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial[J].JAMA,2003;289(16):2073-2082.
16.	Pepine CJ,Handberg EM,Cooper-DeHoff RM,Marks RG,Kowey P,Messerli FH.INVEST Investigators.A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease.The International Verapamil-Trandolapril Study (INVEST):a randomized controlled trial[J].JAMA,2003;290(21):2805-2816.
17.	Liu L,Wang JG,Gong L,Liu G,Staessen JA.Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension.Systolic Hypertension in China (Systtaab2China) Collaborative Group[J].Journal of Hypertension,1998;16(12 Pt 1):1823-1829.
18.	Staessen JA,Fagard R,Thijs L,Celis H,Arabidze GG,Birkenhager WH.Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension.The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators[J].Lancet,1997;350(9080):757-764.
19.	Borhani NO,Mercuri M,Borhani PA,Buckalew VM,Canossa-Terris M,Carr AA.Final outcome results of the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS).A randomized controlled trial[J].JAMA,1996;276(10):785-791.
20.	ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group.The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic:The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) [J].JAMA,2002;288(23):2981-2997.
21.	Anonymous.A prospective study on the effect of nifedipine of the cardiovascular complications in the elderly hypertensive[J].Chinese Journal of Cardiology,1992;20 (5):281-284.
22.	Sun M,Zhou H,Jia Z.Prevention and treatment of stroke after hypertension for ten years in Hunan Province[J].Chinese Journal of Internal Medicine,1997;36(5):312-314.
23.	Zannad F.Effects of calcium antagonists on atherosclerosis progression and intima media thickness[J].Drugs,2000;59(Spec No 2):39-46.
24.	Rodgers A,MacMahon S,Gamble G,Slattery J,Sandercock P,Warlow C.Blood pressure and risk of stroke in patients with cerebrovascular disease.The United Kingdom Transient Ischaemic Attack Collaborative Group[J].BMJ,1996;313(7050):147.
25.	Rashid P,Leonardi-Bee J,Bath P.Blood pressure reduction and secondary prevention of stroke and other vascular events:a systematic review[J].Stroke,2003;34(11):2741-2748.
26.	Ogasawara K,Noda A,Yasuda S,Kobayashi M,Yukawa H,Ogawa A.Effect of calcium antagonist on cerebral blood flow and oxygen metabolism in patients with hypertension and chronic major cerebral artery occlusion:a positron emission tomography study[J].Nuclear Medicine Communications,2003;24(1):71-76.

1. 顾东风,吴锡桂,甘文奇,刘东海,宿少勇,段秀芳,黄广勇.中国成年人高血压的患病率、知晓率、治疗和控制状况[J].中华预防医学杂志,2003;37(2):84～89.
2. Gu DF,Wu XG,Gan WQ,Liu DH,Shu SY,Duan XF,Huang GY.The morbidity rate,treatment and control[J].Chinese Journal of Phylaxiology,2003;37(2):84-89.
3. Song YM,Sung J,Lawlor DA,Smith DG,Shin Y,Ebrahim S.Blood pressure,haemorrhagic stroke,and ischaemic stroke:the Korean national prospective occupational cohort study[J].BMJ,2004;328(7435):324-325.
4. He J,Whelton PK.Elevated systolic blood pressure and risk of cardiovascular and renal disease:overview of evidence from observational epidemiologic studies and randomized controlled trials[J].Am Heart J,1999;138(3 Pt 2):211-219.
5. Luscher TF,Cosentino F.The classification of calcium antagonists and their selection in the treatment of hypertension,A reappraisal[J].Drugs,1998;55(4):509-517.
6. Asmar R,Benetos A,Ghodsi N,Meilhac B,Safar M.Regional arterial hemodynamics and carotid circulation in essential arterial hypertension.Effect of nitrendipine in patients over 40 years of age[J].Presse Medicale,1993;22(35):1770-1775.
7. Zanchetti A,Bond MG,Hennig M,Neiss A,Mancia G,Dal Palu C,et al.European Lacidipine Study on Atherosclerosis investigators.Calcium antagonist lacidipine slows down progression of asymptomatic carotid atherosclerosis:principal results of the European Lacidipine Study on Atherosclerosis (ELSA),a randomized,double-blind,long-term trial[J].Circulation,2002;106(19):2422-2427.
8. Simon A,Gariepy J,Moyse D,Levenson J.Differential effects of nifedipine and co-amilozide on the progression of early carotid wall changes[J].Circulation,2001;103(24):2949-2954.
9. Neal B,MacMahon S,Chapman N.Blood Pressure Lowering Treatment Trialists Collaboration.Effects of ACE inhibitors,calcium antagonists,and other blood-pressure-lowering drugs:results of prospectively designed overviews of randomised trials.Blood Pressure Lowering Treatment Trialists’Collaboration[J].Lancet,2000;356(9246):1955-1964.
10. Kaplan NM.Hypertension trials:1990 to 2000[J].Current Opinion in Nephrology & Hypertension,2001;10(4):501-505.
11. Opie LH,Schall R.Evidence-based evaluation of calcium channel blockers for hypertension:equality of mortality and cardiovascular risk relative to conventional therapy[J].Journal of the American College of Cardiology,2002;39(2):315-322.
12. Kloner RA,Vetrovec GW,Materson BJ,Levenstein M.Safety of long-acting dihydropyridine calcium channel blockers in hypertensive patients[J].American Journal of Cardiology,1998;81(2):163-169.
13. Pahor M,Psaty BM,Alderman MH,Applegate WB,Williamson JD,Cavazzini C,Furberg CD.Health outcomes associated with calcium antagonists compared with other first-line antihypertensive therapies:a meta-analysis of randomised controlled trials[J].Lancet,2000;356(9246):1949-1954.
14. Stason WB,Schmid CH,Niedzwiecki D,Whiting GW,Caubet JF,Luo D,Ross SD,Chalmers TC.Safety of nifedipine in patients with hypertension:a meta-analysis[J].Hypertension,1997;30(1 Pt 1):7-14.
15. Black HR,Elliott WJ,Grandits G,Grambsch P,Lucente T,White WB.CONVINCE Research Group.Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial[J].JAMA,2003;289(16):2073-2082.
16. Pepine CJ,Handberg EM,Cooper-DeHoff RM,Marks RG,Kowey P,Messerli FH.INVEST Investigators.A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease.The International Verapamil-Trandolapril Study (INVEST):a randomized controlled trial[J].JAMA,2003;290(21):2805-2816.
17. Liu L,Wang JG,Gong L,Liu G,Staessen JA.Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension.Systolic Hypertension in China (Systtaab2China) Collaborative Group[J].Journal of Hypertension,1998;16(12 Pt 1):1823-1829.
18. Staessen JA,Fagard R,Thijs L,Celis H,Arabidze GG,Birkenhager WH.Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension.The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators[J].Lancet,1997;350(9080):757-764.
19. Borhani NO,Mercuri M,Borhani PA,Buckalew VM,Canossa-Terris M,Carr AA.Final outcome results of the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS).A randomized controlled trial[J].JAMA,1996;276(10):785-791.
20. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group.The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic:The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) [J].JAMA,2002;288(23):2981-2997.
21. Anonymous.A prospective study on the effect of nifedipine of the cardiovascular complications in the elderly hypertensive[J].Chinese Journal of Cardiology,1992;20 (5):281-284.
22. Sun M,Zhou H,Jia Z.Prevention and treatment of stroke after hypertension for ten years in Hunan Province[J].Chinese Journal of Internal Medicine,1997;36(5):312-314.
23. Zannad F.Effects of calcium antagonists on atherosclerosis progression and intima media thickness[J].Drugs,2000;59(Spec No 2):39-46.
24. Rodgers A,MacMahon S,Gamble G,Slattery J,Sandercock P,Warlow C.Blood pressure and risk of stroke in patients with cerebrovascular disease.The United Kingdom Transient Ischaemic Attack Collaborative Group[J].BMJ,1996;313(7050):147.
25. Rashid P,Leonardi-Bee J,Bath P.Blood pressure reduction and secondary prevention of stroke and other vascular events:a systematic review[J].Stroke,2003;34(11):2741-2748.
26. Ogasawara K,Noda A,Yasuda S,Kobayashi M,Yukawa H,Ogawa A.Effect of calcium antagonist on cerebral blood flow and oxygen metabolism in patients with hypertension and chronic major cerebral artery occlusion:a positron emission tomography study[J].Nuclear Medicine Communications,2003;24(1):71-76.

Chinese Journal of Evidence-Based Medicine

Clinical Evidence of Ca2＋ Channel Blocker in Stroke Prevention

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