Benefits of Nifedipine GITS in Stable Coronary Artery Disease: Further Analysis of the "ACTION" Database

Meredith, P. A. and Elliott, H. L. (2010) Benefits of Nifedipine GITS in Stable Coronary Artery Disease: Further Analysis of the "ACTION" Database. Advances in Therapy, 27(5), pp. 297-306. (doi: 10.1007/s12325-010-0029-2)

Abstract

Introduction: Retrospective analyses of specific subgroups of patients from the database of the ACTION study have evaluated the effectiveness of a nifedipine gastrointestinal therapeutic system (GITS) on clinical outcomes. These subgroups included those patients receiving: 1) full "optimal" therapy at baseline; 2) full "optimal" therapy at baseline but excluding renin angiotensin system (RAS)-blocking drugs; 3) treatment with nifedipine GITS who were not treated with RAS blockers versus those treated with RAS blockers but not nifedipine GITS. Methods: Analyses were performed on an intention-to-treat basis. Treatment groups were compared by log-rank test without adjustment for covariates. Hazard ratios with 95% confidence intervals were obtained using Cox proportional hazards models with treatment allocation as the only covariate. Results: 2461 patients randomized in ACTION were receiving optimal therapy (beta blockers, nitrates, aspirin, statins) excluding RAS blockers at baseline. There were reductions associated with nifedipine GITS compared with placebo in all prespecified endpoints but statistical significance was only achieved for debilitating stroke (48%; P<0.02) and coronary angiography (14%; P<0.05). These benefits were paralleled by a -4.1 and -2.8 mmHg difference between the groups for systolic and diastolic blood pressure, respectively. Patients randomized to nifedipine GITS but no RAS blockers (n=2966) when compared to those receiving RAS blockers but no nifedipine GITS (n=880) had highly statistically significant reductions in cardiovascular events (22%), new-onset heart failure (53%), and debilitating stroke (45%). However, the groups differed in their baseline characteristics. Conclusion: Addition of nifedipine GITS to the treatment regimen of selected patient groups with symptomatic coronary artery disease results in a significant reduction of cardiovascular morbidity. While the interpretation of these subgroup analyses must obviously be cautious, there is a clear message relating to "best practice" treatment of angina, which suggests that "reliance" on RAS blockade may be misplaced and greater attention should be directed towards control of blood pressure

• Item Type: Articles
• Keywords: ACE inhibitor ANGINA angina pectoris Angiotensin angiotensin receptor blockers ARTERY ASPIRIN Attention BENEFITS BETA beta-Blocker BLOOD blood pressure BLOOD-PRESSURE calcium channel blockers CARDIOVASCULAR EVENTS combination drug therapy coronary artery disease CORONARY-ARTERY-DISEASE database DISEASE Drugs EVENTS FAILURE HEART Heart failure HEART-FAILURE HIGH-RISK PATIENTS hypertension INTERVAL MODEL MORBIDITY MORTALITY nifedipine NITRATE outcome OUTCOMES PATIENT patients pharmacology RANDOMIZED CONTROLLED-TRIAL RAS RATIO REDUCTION Scotland statins stroke SYSTEM THERAPIES THERAPY Treatment
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Meredith, Dr Peter
• Authors: Meredith, P. A., and Elliott, H. L.
• College/School: College of Medical Veterinary and Life Sciences
• Journal Name: Advances in Therapy
• ISSN: 0741-238X