The Safety of Calcium Channel Blockers in Controlling Blood Pressure During Cardiac Surgery: A Meta-analysis of Random Controlled Trials

Xueming Chen; Shiyan Chen; Zecheng Yang

doi:10.54097/vw6aav38

Authors

Xueming Chen
Shiyan Chen
Zecheng Yang

DOI:

https://doi.org/10.54097/vw6aav38

Keywords:

Calcium Channel Blockers, Heart Surgery, High Blood Pressure, Safety

Abstract

Background: Intraoperative hypertension is a very common critical condition in cardiac surgery, which may lead to myocardial ischemia, affect the smooth progress of the operation, and even lead to the death of the patient. Therefore, it is necessary to manage perioperative hypertension in cardiac surgery. At present, there are various types of drugs for hypertension control in clinical practice, and it is necessary to select vasoactive drugs suitable for cardiac surgery. Methods: A systematic search was conducted in PubMed (Medline), Embase, and the Cochrane Library databases to compare the safety of calcium channel blockers and other antihypertensive drugs in controlling hypertension during cardiac surgery, with the search ending in July 2024. For continuous variables, we utilized combined weighted mean difference (WMD) with a 95% confidence interval (CI) and risk ratio (RR) with a 95% confidence interval to assess both efficacy and safety. Results: A total of six randomized controlled trials were included, with a total of 1886 patients. There was no significant difference in mortality between calcium channel blockers and other vasodilators (RR=0.75, 95% CI: 0.45,1.26, P =0.28; I²=0%, P=0.75). Also, there was no significant difference in the incidence of atrial fibrillation (RR=1.09, 95% CI: 0.94,1.26, P=0.26; I²=13%, P=0.33). In addition, there were no significant differences in the incidence of myocardial infarction (RR=0.76, 95% CI: 0.41,1.39, P=0.37; I²=0%, P=0.55) and renal insufficiency (RR=0.92, 95% CI: 0.65,1.31, P=0.66; I²=40%, P=0.19) between the two groups. Finally, there was no significant difference in the incidence of total adverse events between the two groups (RR=1.05, 95% CI: 0.87,1.27, P=0.60; I²=0%, P=0.68). Conclusion: Compared with other vasodilators, there is no significant difference in the safety of calcium channel blockers in controlling blood pressure in cardiac surgery.

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References

[1] T. G Weiser, S. E Regenbogen, K. D Thompson, et al. “An estimation of the global volume of surgery: A modelling strategy based on available data, ” The Lancet, vol. 372, pp. 139-144, 2008.

[2] A. S Awad, M. E Goldberg. “Role of clevidipine butyrate in the treatment of acute hypertension in the critical care setting: A review,” Vasc Health Risk Manag, vol. 6, pp. 457-464, 2010.

[3] A Vuylsteke, R. O Feneck, A Jolin-Mellgård, et al. “Perioperative blood pressure control: A prospective survey of patient management in cardiac surgery, ” J Cardiothorac Vasc Anesth,vol. 14, pp. 269-273, 2000.

[4] Marik P E, Varon J. “Perioperative hypertension: A review of current and emerging therapeutic agents, ” J Clin Anesth,vol. 21, pp. 220-229, 2009.

[5] M. A Weber, E. L Schiffrin, W. B White, et al. “Clinical practice guidelines for the management of hypertension in the community: A statement by the american society of hypertension and the international society of hypertension, ” J Clin Hypertens (Greenwich), vol.16, pp. 14-26, 2014.

[6] X. L Cheng, J. G He, Z. H Liu, et al. “Pulmonary vascular capacitance is associated with vasoreactivity and long-term response to calcium channel blockers in idiopathic pulmonary arterial hypertension, ” Lung, vol. 194, pp. 613-618, 2016.

[7] Y Lin, L Ma. “Blood pressure lowering effect of calcium channel blockers on perioperative hypertension: A systematic review and meta-analysis, ” Medicine (Baltimore),vol. 97, pp. e1352, 2018.

[8] A. F Merry, E. G Avery, N. A Nussmeier, et al. “Clevidipine compared with nitroglycerin for blood pressure control in coronary artery bypass grafting: A randomized double-blind study, ” Canadian Journal of Anesthesia,vol.61, pp. 398-406, 2014.

[9] S Aronson. “Clevidipine in the treatment of perioperative hypertension: Assessing safety events in the eclipse trials, ” Expert Rev Cardiovasc Ther,vol. 7, pp. 465-472, 2009.

[10] N Singla, D. C Warltier, S. D Gandhi, et al. “Treatment of acute postoperative hypertension in cardiac surgery patients: An efficacy study of clevidipine assessing its postoperative antihypertensive effect in cardiac surgery-2 (escape-2), a randomized, double-blind, placebo-controlled trial, ” Anesth Analg, vol. 107, pp. 59-67, 2008.

[11] J. h Levy, M. Y Mancao, R Gitter, et al. “Clevidipine effectively and rapidly controls blood pressure preoperatively in cardiac surgery patients: The results of the randomized, placebo-controlled efficacy study of clevidipine assessing its preoperative antihypertensive effect in cardiac surgery-1, ” Anesth Analg, vol. 105, pp. 918-925, 2007.

[12] F Toraman, H Karabulut, O Goksel, et al. “Comparison of antihypertensives after coronary artery surgery, ” Asian Cardiovascular and Thoracic Annals,vol. 13, pp. 302-306, 2005.

[13] R. J Vecht, K. T Swanson, E. P Nicolaides, et al. “Comparison of intravenous nicardipine and nitroglycerin to control systemic hypertension after coronary artery bypass grafting, ” American journal of cardiology, vol.64, pp. 19-21, 1989.

[14] C. E Haas, J. M LeBlanc. “Acute postoperative hypertension: A review of therapeutic options, ” Am J Health Syst Pharm,vol. 61, pp. 1661-1673, 2004.

[15] N Kieler-Jensen, A Jolin-Mellgård, M Nordlander, et al. “Coronary and systemic hemodynamic effects of clevidipine, an ultra-short-acting calcium antagonist, for treatment of hypertension after coronary artery surgery, ” Acta Anaesthesiol Scand, vol. 44, pp. 186-193, 2000.

[16] T Pasch, V Schulz, G Hoppelshäuser. “Nitroprusside-induced formation of cyanide and its detoxication with thiosulfate during deliberate hypotension, ” J Cardiovasc Pharmacol,vol. 5, pp. 77-85, 1983.

[17] D. R Abernethy, J. B Schwartz. “Calcium-antagonist drugs, ” N Engl J Med, vol. 341, pp. 1447-1457, 1999.

[18] B. J Materson. “Calcium channel blockers. Is it time to split the lump?, ” Am J Hypertens, vol. 8, pp. 325-329,1995.

[19] F Toraman, H Öztiryaki, H Karabulut, et al. “Comparative study of diltiazem, nitroglycerin, and sodium nitroprusside for controlling hypertension following coronary artery bypass surgery, ” Turk Kardiyoloji Dernegi Arsivi, vol. 30, pp. 530-533, 2002.

[20] S Hayase, Y Yano, K Ogawa, et al. “vasodilator therapy utilizing nitroprusside and nitroglycerin after coronary artery surgery, ” Kyobu Geka, vol. 42, pp. 189-194,1989.