title: Calcium channel blockade to prevent stroke in hypertension: a meta-analysis of 13 studies with 103,793 subjects.
abstract: BACKGROUND
  The possibility that specific antihypertensive treatments may prevent the occurrence of stroke more effectively than other treatments remains unproved. We undertook a meta-analysis to assess whether calcium channel blockers (CCBs) are associated with a lesser risk of stroke as compared with other antihypertensive drugs.
  
  
  METHODS
  Through Medline we identified 13 major studies conducted in hypertensive subjects for a total of 103,793 subjects. Overall, there were 4040 incident cases of stroke, 1789 among 43,053 subjects randomized to CCBs and 2251 among 60,740 subjects randomized to different antihypertensive drugs.
  
  
  RESULTS
  Considering all 13 trials, a pooled reduction in the risk of stroke was observed among subjects allocated to CCBs (odds ratio 0.90, 95% confidence interval [95% CI] 0.84-0.96; P =.002). The risk of stroke was significantly lower among subjects allocated to dihydropyridine CCBs than among those randomized to alternative drugs (odds ratio 0.90, 95% CI 0.84-0.97; P =.006), whereas the effect of non-dihydropyridine CCBs did not achieve significance (odds ratio 0.92, 95% CI 0.81-1.04). In a meta-regression analysis of these trials, the protection from stroke conferred by CCBs appeared unrelated to the degree of systolic blood pressure reduction.
  
  
  CONCLUSIONS
  These findings suggest that CCBs decrease the risk of stroke more effectively than other treatments in patients with essential hypertension and that such an effect might not be completely explained by a better antihypertensive response. Calcium channel blockers should be considered in hypertensive subjects at increased risk of stroke.
authors.affiliation: Departments of Cardiovascular Disease and Internal Medicine, Hospital R. Silvestrini, Perugia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Angeli
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Reboldi
authors.forename: Roberto
authors.initials: R
authors.lastname: Gattobigio
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bentivoglio
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
authors.forename: Carlo
authors.initials: C
authors.lastname: Porcellati
mesh_terms: D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D002121:Calcium Channel Blockers