Title:Calcium Channel Blockers in Restoration of Endothelial Function: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Volume: 26
Issue: 29
Author(s): Miroslav Radenković*, Marko Stojanović and Milica Prostran
Affiliation:
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade,Serbia
Keywords:
Calcium channel blockers, endothelial dysfunction, flow-mediated dilation, meta-analysis, systematic
review, cardiovascular risk prevention, rational pharmacotherapy.
Abstract: Background: Clinical evaluation of the Endothelial Function (EF) is becoming an
essential step in the quality assessment of cardiovascular risk prevention and rational pharmacotherapy
of cardiovascular disorders. The existing pieces of evidence suggested that Calcium
Channel Blockers (CCB) can induce positive effects on impaired EF.
Objective: To evaluate the effects of CCB on EF, we performed a meta-analysis of available
data from randomized and placebo-controlled or other treatment-controlled clinical studies
encompassing effects of CCB on EF, as measured by Flow-Mediated Dilation (FMD) of the
brachial artery.
Methods: The relevant clinical studies were searched by systematic exploration of the appropriate
databases until November 30, 2017. A random-effect model was conducted. The primary
outcome was the percentage change in FMD between the baseline and the final levels in
response to investigated drugs.
Results: Fifteen randomized clinical studies with 33 arms were identified. CCB improved
FMD more pronounced than thiazide diuretics - TD (3 studies, 157 participants,
WMD=2.08%, 95% CI=0.35-3.80%; P=0.02). Oppositely, ACE Inhibitors (ACEI) and Angiotensin
Receptor Blockers (ARB) notably improved FMD if compared to CCB (CCB vs.
ACEI: 5 studies, 533 participants, WMD = ‐1.62%, 95% CI = ‐2.74% to ‐0.50%; P=0.005;
and CCB vs. ARB: 9 studies, 669 participants, WMD = ‐1.52%, 95% CI = ‐2.22% to
‐0.81%; P=0.0001). CCB effects on EF were similar to those evoked by beta blockers or placebo.
Conclusion: CCB improved EF to a more prominent extent only if paralleled to TD, while
inversely; ACEI and ARB were more effective in augmenting FMD.
