Dihydropyridine calcium channel blockers and cardiovascular outcomes in elderly patients: a population-based study |
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Authors: | Bucci Claudia Mamdani Muhammad M Juurlink David N Tu Jack V |
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Affiliation: | 1Department of Pharmacy, Sunnybrook Health Sciences Centre;;2Institute for Clinical Evaluative Sciences;;3Faculty of Medicine, University of Toronto, and Department of Medicine, Toronto, Ontario |
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Abstract: | 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. |
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Keywords: | Acute coronary syndrome Acute myocardial infarction Angina Dihydropyridine calcium channel blockers |
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