Is There A Dose-related Increase in Mortality in Patients with Coronary
Heart Disease On Nifedipine?
Clinical Question
Does nifedipine increase or decrease mortality in patients with coronary
heart disease?
Clinical Bottom Line
- There may be a slight increase in the risk of mortality on 80mg/day of
short -acting nifedipine preparations.
- There was no statistically significant increase in the risk of mortality in
all patients in this study.
The Evidence
|
Mortality |
|
| Dose (mg/day) |
Relative Risk |
95% CI |
| 30 |
1.01 |
0.73-1.42 |
| 40 |
1.09 |
0.87-1.35 |
| 50 |
1.03 |
0.44-2.37 |
| 60 |
1.18 |
0.93-1.50 |
| 80 |
2.83 |
1.35-5.93 |
| 100 |
2.2 |
0.69-6.99 |
| ALL dosages |
1.16 |
1.01-1.13 |
Comments
- This study was a meta-analysis of published studies.
- There was moderate heterogeneity among trials included in the 40 and 60 mg
groups. However, heterogeneity was low in the 80 mg and Total groups.
- No sub-group analyses were done according to patients' natural histories of
disease (post-MI, Diabetes Mellitus, severity of HTN, stable angina, unstable
angina, etc.)
- The validity of this study suffers from failure to provide inclusion
criteria, to report on validity assessments of the individual trials included,
and to indicate that assessments were reproducible.
- Despite these flaws, this has sparked considerable interest in the use of
short acting Calcium antagonists, especially at higher doses, in patients
stratified to be high risk for coronary events. Further outcomes research is
needed in this area to be conclusive. For the time being, it may be wise to
avoid high-dose nifedipine in patients with hypertension and multiple risk
factors for a coronary event.
APPRAISED BY: Yogenthiran Saunthararajah, MD
DATE: September 9, 1996.
REVIEWED BY: Patrick J. Sousa, MD
Furberg CD, Psaty BM, Meyer JV. Nifedipine: Dose-related increase in
mortality seen in patients with coronary heart disease. Circulation,
1995;92:1326-1331.
