Adverse effects of hypertensive agents

Evidence Summaries

Level of Evidence = A
Calcium channel blockers are as safe as beta blockers with respect to serious adverse effects. Headache and oedema are more common with calcium channel blockers than with diuretics, and flushing are more common with calcium channel blockers than with beta blockers.

A systematic review 1 including 28 RCTs with a total of 3073 subjects assessing calcium channel blockers (CCB) versus beta blockers or diuretics was abstracted in DARE. There was no difference in the total incidence of serious adverse effects. Headache and oedema occurred significantly more frequently in CCB. The risk difference between CCBs and diuretics was 7.36% (95% CI 1.90 to 12.81%) for headache and 6.57% (95% CI 1.29% to 11.84%) for oedema. Flushing occurred 8.75% more frequently with CCBs compared with beta blockers (95% CI 4.00% to 13.94%). Tachycardia and oedema occurred in the CCB group slightly more frequently than beta blockers (difference not statistically significant).

Comment: A well performed systematic review.

References

1. Sakai H, Hayashi K, Origasa H, Kusunoki T. An application of meta-analysis techniques in the evaluation of adverse experiences with antihypertensive agents. Pharmacoepidemiol Drug Saf 1999 May;8(3):169-77.  [PMID:15073926]


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