Ischaemic heart disease: increased mortality with short acting nifedipine.

Clinical bottom line (level 2a)

  1. Patients with ischaemic heart disease who took short acting nifedipine were at increased risk of dying (NNH = 100 at unknown) .
Furberg et al: Circulation 1995; 92: 1326-1331
Expires July 2003

The study

Systematic review of randomised controlled trials of
  • Patients: coronary artery disease
  • Intervention: short acting nifedipine compared with placebo
  • Outcome: mortality


    • Articles found in ? using ?, ? (search terms: not detailed )

    Selection criteria: as above
    Appraisal criteria: not detailed
    Articles excluded if:

    Sixteen studies involving 8350 patients were included (12 in patients with MI, 3 with unstable angina, 1 with stable angina)
    There was no significant heterogeneity.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNH
    (95% CI)
    death unknown 274/4183
    (6.6%)    		 1.16
    (1.01 to 1.33)     		100
    (50 to 1600)

    Comments

    1. A dose-response relationship was noted, with increases in mortality being noted at 60 mg daily or more.
    2. Short acting nifedipine is now rarely used- most patients are on sustained released formulations. The recent INSIGHT trial demonstrated that long-acting nifedipine is safe and effective in controlling high blood pressure.
    3. The lack of information on selection and appraisal techniques makes this review's conclusions less certain. Potentially important studies may have been missed, and flawed data included.

    Citation

    1. Furberg CD, Psaty BM, Meyer JV: Nifedipine: dose-related increase in mortality in patients with coronary heart disease. Circulation 1995; 92: 1326-1331
    Search Terms: nifedip* in Cochrane
    Contributor: Chris Ball and Clare Wotton, July 2000
    Reviewer: Arnold Baas

    Clinical Question.
    Patient adult, hypertensive, ischaemic heart disease
    Intervention or Exposure calcium-channel blocker
    Outcome death