Long-term outcomes of lercanidipine versus other calcium channel blockers in newly diagnosed hypertension: a nationwide cohort study

Abstract

Objective: Calcium channel blockers (CCBs) have been proved to have beneficial effects on cardiovascular (CV) outcomes, especially in stroke. Lercanidipine, a highly lipophilic CCB, lacks data regarding long-term outcomes including: CV, stroke, renal and all-cause mortality. This retrospective cohort study aims to clarify this.

Patients and methods: A total of 144,630 newly diagnosed hypertension (HTN) patients (age: 18–65 years) in 2005 from the Taiwan’s National Health Insurance Research Database were enrolled in this observational study. A pure hypertension population was fetched by excluding all chronic diseases in the Charlson Comorbidities Index. Patients were stratified into the lercanidipine group (n = 1303) and the propensity-score-matched comparative group (nifedipine, amlodipine or felodipine, n = 15,301).

Results: Compared to other CCBs, lercanidipine didn’t have a significant difference on the study endpoints. In individual head-to-head comparisons, lercanidipine was shown to be superior to nifedipine in incident stroke with an adjusted HR with 95% CI of 0.526 (0.347–0.797) (p = .0025). The key limitations were that personal variables, such as smoking habits, alcohol intake, body mass index and physical activity and blood pressure profiles were not available in the nationwide registry database.

Conclusion: In newly diagnosed patients with hypertension, lercanidipine was superior to nifedipine in the six-year period when the analyzed endpoint was stroke.

Keywords:

• Calcium channel blocker
• cardiovascular mortality
• chronic kidney disease
• lercanidipine
• peripheral vascular disease
• stroke

Transparency

Declaration of funding

This manuscript received no funding.

Author contributions: K.-H.C. participated in the generation of the original ideas, in the study design and in the analysis of data, in drafting of the manuscript, in revising it critically for important intellectual content and in final approval of the manuscript submitted. Other authors participate in 1) conception and design or analysis and interpretation of data, or both: K.-C.C., K.-Y.C., Y.-H.Y. and W.-T.L.; 2) drafting of the manuscript or revising it critically for important intellectual content: Y.-H.Y., C.-W.L. and W.-T.L.; and 3) final approval of the manuscript submitted: Y.-H.Y. and W.-T.L.

Declaration of financial/other relationships

K.-H.C., K.-C.C., K.-Y.C., Y.-H.Y., C.-W.L., and W.-T.L. have disclosed that they have no relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

We are grateful for the agreement of access to the NHIRD provided by the Taiwan National Health Insurance Administration and statistical calculation by Yi-Hsin Yang’s team in the Center for Medical Informatics and Statistics of Kaohsiung Medical University. We also thank Linda Lin and Alexandre Morais Carneiro for kindly providing English revision for us.