Network Meta-analysis Of Secondary Prevention Of Hypertensive Stroke By Calcium Channel Blockers

Objective:To systematically evaluate the efficacy and safety of different calcium channel blockers(CCBs)for secondary prevention of hypertensive stroke.Methods:By searching PubMed,Embase,Cochrane Library,CNKI,Wanfang,Weipu and other databases,we collected the randomized controlled trials(RCTs)published before October 2019 on different CCBs for secondary prevention of hypertensive stroke.Two professional commentators independently screened and included the documents according to the pre-established inclusion and exclusion criterias,and conducted information extraction and quality evaluation on the final included studies,and conducted network meta-analysis(NMA)Stata15.1 software.Results:Sixteen RCTs involving 3,994 patients were included in the study.The results of network meta-analysis showed that levoamodipine was more effective than amlodipine(RR 0.30,95% CI 0.10-0.86),nifedipine(RR 0.40,95% CI 0.00-0.50)in reducing the effectiveness of hypertensive stroke recurrence and the difference was statistically significant;cilnidipine was more effective than nifedipine(RR 0.05,95% CI 0.01-0.63),and the difference was statistically significant;other CCBs had no statistically significant difference in the rate of stroke recurrence;therefore,in the application of CCBs on preventing stroke recurrence in patients with hypertensive stroke,levoamodipine was more effective than amlodipine(RR 0.30,95% CI 0.10-0.86),nifedipine(RR 0.40,95% CI 0.00-0.50)in reducing the effectiveness of hypertensive stroke recurrence;cilnidipine was more effective than nifedipine(RR 0.05,95% CI 0.01-0.63).Conclusion:Available evidence suggests that levoamlodipine is preferred when CCBs are used to prevent stroke recurrence in patients with hypertensive stroke,followed by cilnidipine,amlodipine,lacidipine,and nifedipine.Limited by the number and quality of these researches,the conclusions above need to be verified by more high-quality studies,so than it may be used for clinical treatment.