Results of a meta-analysis comparing the tolerability of lercanidipine and other dihydropyridine calcium channel blockers

Background. Results from clinical studies suggest that the dihydropyridine calcium channel blocker (d-CCB) lercanidipine may be associated with a lower incidence of peripheral edema than are older d-CCBs. Aim. To conduct a meta-analysis of published data from randomized controlled trials (RCTs) to assess the relative risk (RR) of d-CCB-specific adverse events (AE) with lercanidipine versus the older d-CCBs (first generation: amlodipine, felodipine, and nifedipine), and versus the other lipophilic d-CCBs (second generation: lacidipine and manidipine). Material and methods. A systematic literature search (all years, through August 11 2008) of MEDLINE, EMBASE, and the Cochrane Library was conducted for English-language reports of single- or double-blind RCTs of ≥4 weeks’ duration that compared the tolerability of lercanidipine with other d-CCBs in participants with mild (140- 159/90-99 mm Hg) and moderate (160-179/100-109 mm Hg) hypertension. Results. Eight RCTs (6 used first-generation drugs, and 4 used second-generation drugs) met the criteria for inclusion. Efficacy outcomes for lowering blood pressure did not differ statistically between lercanidipine and either generation of d-CCBs. Compared with the first generation, lercanidipine was associated with a reduced risk of peripheral edema (52/742 with lercanidipine vs. 88/627 with first generation; RR=0,44 [95% CI 0,31-0,63]), but not flushing or headache. The frequency of peripheral edema, flushing, and headache did not differ statistically between lercanidipine and the second generation drugs. Study participants were less likely to withdraw from the RCTs because of peripheral edema (RR=0,24 [95% CI 0,12-0,47]) or any AE (RR=0,51 [95% CI 0,33-0,77]) when treated with lercanidipine rather than a drug from the first generation, but not when treated with lercanidipine rather than second-generation drugs. Conclusion. Lercanidipine was associated with a lower risk of peripheral edema and a lower risk of treatment withdrawal because of peripheral edema than were the first-generation, but not the second-generation, d-CCBs