Dihydropyridine calcium channel blockers and cardiovascular outcomes in elderly patients: a population-based study

BACKGROUND:

Dihydropyridine calcium channel blockers are widely used for the treatment of hypertension and angina. Despite safety concerns associated with short-acting agents, increasing evidence supports the safety of long-acting dihydropyridines. Although amlodipine is the best studied of these, there are few studies comparing it with nifedipine.

OBJECTIVE:

To examine the association between hospitalization for acute coronary syndromes and treatment with amlodipine or extended-release nifedipine in patients 65 years of age and older. The primary objective was a composite of hospital admission for angina or acute myocardial infarction.

METHODS:

The present population-based, retrospective cohort study used linked health care databases from Ontario. Propensity scores were used to identify highly similar patients started on amlodipine or extended-release nifedipine between April 1997 and March 2002. Time-to-event analysis was conducted using Cox proportional hazards models.

RESULTS:

The analysis included 24,190 patients (44% male; mean age 75 years) treated with amlodipine or extended-release nifedipine (n=12,095 each). The number of patients reaching the primary end point was 362 (3%) and 294 (2.4%) in the amlodipine and nifedipine groups, respectively. The groups were similar in a large number of demographic and clinical characteristics. No significant differences were observed among users of extended-release nifedipine (adjusted hazard ratio 0.91, 95% CI 0.74 to 1.13) relative to amlodipine.

CONCLUSIONS:

These findings suggest that amlodipine and extended-release nifedipine are not associated with differential rates of acute coronary events in older patients.