title: Efficacy and safety of dual calcium channel blockade for the treatment of hypertension: a meta-analysis.
abstract: BACKGROUND
  Dual calcium-channel blocker (CCB) with a dihydropyridine (DHP) and a nondihydropyridine (NDHP) has been proposed for hypertension treatment. However, the safety and efficacy of this approach is not well known.
  
  
  METHODS
  A MEDLINE/EMBASE/CENTRAL search for randomized clinical trials published on this topic from 1966 to February 2012 was performed. Efficacy outcomes of decrease in systolic (SBP) and diastolic (DBP) blood pressures from baseline, changes in heart rate (HR), and adverse effects were compared between dual CCB therapy vs. DHP or NDHP. SBP, DBP, and HR were expressed as weighted mean deviation (WMD).
  
  
  RESULTS
  A total of 6 studies with 153 patients were included. Dual CCB produced a significantly greater reduction in SBP (21.6±9.2 mmHg) from baseline than DHP (10.3±6.3 mmHg (WMD = 10.9 mmHg, P < 0.0001)) or NDHP (8.9±4.2 mmHg (WMD = 14.1 mmHg, P = 0.002)). Dual CCB therapy reduced DBP from baseline more than either monotherapy (dual CCB = 17.5±10.2 mmHg vs. DHP = 11.6±8.7 mmHg, WMD = 5.5 mmHg, P < 0.001; and NDHP = 10.5±5.6 mmHg, WMD = 5.3 mmHg, P = 0.03). Dual CCB therapy had significantly lower HR compared to DHP (P < 0.001) but was comparable to NDHP (P = 0.12) (Delta change dual CCB = -4.0±3.5 vs. DHP = -2.0±1.5 and NDHP = -6.0±5.0 beats/min). Dual CCB therapy did not increase adverse effects.
  
  
  CONCLUSIONS
  Dual CCB therapy lowers blood pressure significantly better than CCB monotherapy, without an increase in adverse events. However, given the lack of long-term outcome data on efficacy and safety, dual CCB therapy should be used with restraint, if at all. Large-scale long-term trials are needed to further evaluate such a strategy.
authors: St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors: Carlos L
authors: CL
authors: Alviar
authors: Santhosh
authors: S
authors: Devarapally
authors: Girish N
authors: GN
authors: Nadkarni
authors: Jorge
authors: J
authors: Romero
authors: Alexandre M
authors: AM
authors: Benjo
authors: Fahad
authors: F
authors: Javed
authors: Bryan
authors: B
authors: Doherty
authors: Hyuensok
authors: H
authors: Kang
authors: Sripal
authors: S
authors: Bangalore
authors: Franz H
authors: FH
authors: Messerli
mesh_terms: D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002121:Calcium Channel Blockers / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D004095:Dihydropyridines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D002121:Calcium Channel Blockers; D004095:Dihydropyridines; C038806:1,4-dihydropyridine