LONG Youlin 1 , GUO Qiong 1 , LIU Guanjian 1 , LUO Shanxia 2 , DU Liang 1
  • 1. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
  • 2. Department of Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
DU Liang, Email: duliang0606@vip.sina.com
S-amlodipine; Hypertension; Systematic review; Meta-analysis; Randomized controlled trial
10.7507/1002-0179.201901124
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Objective To assess the efficacy and safety of S-amlodipine versus amlodipine, and 2.5 mg S-amlodipine versus 5.0 mg S-amlodipine in treating hypertension.Methods Medline, Embase, CENTRAL, ClinicalTrials.gov, China National Knowledge Infrastructure, WanFang Data, and VIP databases were searched for randomized controlled trials (RCTs) about S-amlodipine for hypertension till January 2018. Two reviewers independently reviewed the literature, extracted data, and assessed the risk of bias of included RCTs. RevMan 5.3 software was used for meta-analysis.Results All together 16 RCTs involving 3 946 patients were included. The results of meta-analysis showed that: (1) S-amlodipine vs. amlodipine: the levels of reduction in intima-media thickness [mean difference (MD)=–0.21 mm, 95% confidence interval (CI) (–0.35, –0.07) mm, P=0.003], pulse pressure [MD=–5.90 mm Hg (1 mm Hg=0.133 kPa), 95%CI (–8.57, –3.23) mm Hg, P<0.000 1], systolic pressure [MD=–5.08 mm Hg, 95%CI (–9.61, –0.55) mm Hg, P=0.03], and diastolic pressure [MD=–4.60 mm Hg, 95%CI (–7.82, –1.39) mm Hg, P=0.005] were all higher in the S-amlodipine group than in the amlodipine group, and the incidence of adverse event [relative risk=0.55, 95%CI (0.40, 0.77), P=0.000 4] was lower in the S-amlodipine group. But no significant differences were found in changes of left ventricular posterior wall thickness, heart rate, blood pressure variability between the two groups. (2) 2.5 mg S-amlodipine vs. 5.0 mg S-amlodipine: the levels of reduction in systolic pressure [MD=4.17 mm Hg, 95%CI (2.23, 6.11) mm Hg, P<0.000 1] and diastolic pressure [MD=1.84 mm Hg, 95%CI (1.17, 2.52) mm Hg, P<0.000 01] were higher in the 5.0 mg S-amlodipine group than in the 2.5 mg S-amlodipine group, but no significant difference was found in the incidence of adverse event between the two groups. None of the primary outcomes was analyzed because they were not reported by any one of the included studies.Conclusions Current evidence shows that S-amlodipine is slightly superior to amlodipine in reducing intima-media thickness which could indirectly reflect the effect of interventions on endpoint outcome measures, blood pressure, pulse pressure, and the incidence of adverse event. 5.0 mg S-amlodipine is slightly superior to 2.5 mg S-amlodipine in reducing blood pressure, though comparable with the latter in the effect on incidence of adverse event. The effect of S-amlodipine on all the primary outcomes is unclear because none of the included studies reported on those. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify the above conclusions.

Citation： LONG Youlin, GUO Qiong, LIU Guanjian, LUO Shanxia, DU Liang. Efficacy and safety of S-amlodipine versus amlodipine and 2.5 mg S-amlodipine versus 5.0 mg S-amlodipine for hypertension: a systematic review and meta-analysis. West China Medical Journal, 2019, 34(4): 410-418. doi: 10.7507/1002-0179.201901124 Copy

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