PMID- 24683248
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20140513
LR  - 20211021
IS  - 0011-393X (Print)
IS  - 0011-393X (Linking)
VI  - 71
IP  - 1
DP  - 2010 Feb
TI  - Tolerability and effectiveness of (S)-amlodipine compared with racemic amlodipine 
      in hypertension: a systematic review and meta-analysis.
PG  - 1-29
LID - 10.1016/j.curtheres.2010.02.005 [doi]
AB  - BACKGROUND: Amlodipine is a calcium channel blocker prescribed for the management 
      of angina and hypertension. As a racemic mixture, amlodipine contains (R)- and 
      (S)-amlodipine isomers, but only (S)-amlodipine as the active moiety possesses 
      therapeutic activity. Based on pharmacologic research, it remains uncertain if 
      (S)-amlodipine alone has similar efficacy and fewer associated adverse events 
      (AEs) compared with the racemic mixtures. OBJECTIVE: The aim of this systematic 
      review and meta-analysis was to determine the effectiveness and tolerability of 
      (S)-amlodipine compared with that of racemic amlodipine. METHODS: A systematic 
      literature search was performed using MEDLINE (1966-2009), EMBASE (1966-2009), 
      the Cochrane Central Register of Controlled Trials (issue 3, 2009), the Chinese 
      Biomedical Database (1978-2009), and the China National Knowledge Internet 
      (1980-2009). All randomized controlled trials (RCTs) comparing (S)-amlodipine 2.5 
      mg and racemic amlodipine 5.0 mg in the treatment of hypertension were included 
      in the review. The outcome measures to be collected were cardiovascular events, 
      systolic blood pressure (SBP), diastolic BP (DBP), and AEs. Quality assessments 
      of clinical trials were conducted using a modified Jadad Scale, with trials being 
      rated as low quality (score 0-3) or high quality (score 4-7). Meta-analysis of 
      the included studies was performed using RevMan software. RESULTS: Of the 229 
      references identified, 214 were excluded after screening the titles, abstracts, 
      or full texts. Fifteen RCTs were included, of which 13 were in Chinese and 2 in 
      English. Based on the Jadad Scale score, 3 of the RCTs were classified as high 
      quality (score 5 or 6) and the remaining 12 as low quality (score 1-3). None of 
      the trials evaluated cardiovascular events beyond 40 weeks. Meta-analysis of the 
      15 trials indicated that (S)-amlodipine was not significantly different from 
      racemic amlodipine in the effect on BP. When only high-quality studies were 
      included, after 4 weeks' treatment, the weighted mean difference (WMD) of SBP and 
      DBP decrease (1 study) was -2.84 (95% CI, -6.42 to 0.74) with (S)-amlodipine and 
      -1.71 (95% CI, -3.48 to 0.06) with racemic amlodipine. After 8 weeks' treatment, 
      the WMD of SBP and DBP decrease (2 studies) was -1.13 (95% CI, -5.29 to 3.03) and 
      -1.34 (95% CI, -2.67 to -0.01), respectively. The risk difference (RD) for the 
      number of patients who experienced AEs with (S)-amlodipine and racemic amlodipine 
      was found to be -0.04 (95% CI, -0.06 to -0.02). When all the trials were 
      included, (S)-amlodipine treatment was associated with significantly less edema 
      than racemic amlodipine (RD, -0.02; 95% CI, -0.03 to 0.00); however, when only 
      high-quality studies (2 studies) were included, no difference was found between 
      the 2 groups (RD, 0.01; 95% CI, -0.02 to 0.03). One high-quality study found 
      significant differences in increases in aspartate and alanine aminotransferase 
      activities in the 2 groups (RD, 0.08; 95% CI, 0.01 to 0.05). No significant 
      differences between the 2 groups were found in the incidence of headache (RD, 
      0.00; 95% CI, -0.02 to 0.01) or flushing (RD, -0.01; 95% CI, -0.02 to 0.00). 
      CONCLUSIONS: The majority of the clinical trials comparing (S)-amlodipine and 
      racemic amlodipine treatment were low quality (12/15 [80%]). According to the 
      limited evidence, there were no significant differences between (S)-amlodipine 
      2.5 mg and racemic amlodipine 5.0 mg in controlling BP. When all the trials were 
      considered, (S)-amlodipine treatment was associated with significantly less edema 
      than racemic amlodipine; however, when only high-quality trials were included, no 
      significant difference was found. More long-term, high-quality RCTs with 
      cardiovascular events as the primary outcome are needed to compare the safety and 
      efficacy of (S)-amlodipine and racemic amlodipine.
FAU - Liu, Fang
AU  - Liu F
AD  - Department of Pharmacy, Peking University Third Hospital, Beijing, China.
FAU - Qiu, Meng
AU  - Qiu M
AD  - Department of Geriatrics, Peking University Third Hospital, Beijing, China.
FAU - Zhai, Suo-Di
AU  - Zhai SD
AD  - Department of Pharmacy, Peking University Third Hospital, Beijing, China.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Curr Ther Res Clin Exp
JT  - Current therapeutic research, clinical and experimental
JID - 0372621
PMC - PMC3967363
OTO - NOTNLM
OT  - (S)-amlodipine
OT  - hypertension
OT  - systematic review
EDAT- 2010/02/01 00:00
MHDA- 2010/02/01 00:01
PMCR- 2010/02/01
CRDT- 2014/04/01 06:00
PHST- 2010/01/06 00:00 [accepted]
PHST- 2014/04/01 06:00 [entrez]
PHST- 2010/02/01 00:00 [pubmed]
PHST- 2010/02/01 00:01 [medline]
PHST- 2010/02/01 00:00 [pmc-release]
AID - S0011-393X(10)00007-X [pii]
AID - 10.1016/j.curtheres.2010.02.005 [doi]
PST - ppublish
SO  - Curr Ther Res Clin Exp. 2010 Feb;71(1):1-29. doi: 
      10.1016/j.curtheres.2010.02.005.