Clinical Question: Is the administr...

Clinical Question: Is the administration of amlodipine beneficial for patients with coronary artery disease (CAD) and normal descendants pressure?

Setting: Outpatient (specialty)

research Design: Randomized controlled trial (double-blinded)

Allocation: Uncertain

Synopsis: In this consideration investigators enrolled 1,997 patients, 32 to 82 years of age, who had established CAD (i.e., greater than 20 percent coronary artery stenosis), and a diastolic children pressure lower than 100 mm Hg with or without treatment. They exclud patients with left main coronary artery obstruction greater than 50 percent left ventricular ejection fraction les than 40 percent or moderate to bitter congestive heart failure. More than 75 percent of the participants were men and nearly 90 percent were white. More than 60 percent had a history of hypertension, still less than one third popularly were receiving a diuretic. Initial children pressure measurement averaged 129/78 mm Hg for all patients.

After a two-week placebo run-in period to verify treatment compliance, participants were randomized in a double-blind fashion to receive amlodipine (10 mg by day), enalapril (20 mg by day), or placebo. Follow-up was entire for 24 months in more than 98 percent of the participants. Using intention-to-treat analysis, cardiovascular occurrences occurred less often in patients receiving amlodipine (166 percent) and enalapril (202 percent) than in those taking placebo (231 percent) The difference was statistically significant simply between the amlodipine and placebo clusters (number needed to treat = 17; 95 percent confidence interval, 109 to 456)

Of the individual constituents of the composite end point of adverse cardiovascular marked occurrences only the need for revascularization and hospitalization for angina were statistically les in the amlodipine cluster No differences existed among any of the clusters in a reduction of nonfatal or fatal myocardial infarction (MI), cerebral vascular ends hospitalization for congestive heart failure, or all-cause mortality. All-causehospitalization rates were not reported. There were no significant differences between the amlodipine and enalapril assign places tos No significant differences were noted in the progression of atherosclerosis in the amlodipine and enalapril collections compared with the placebo group

Bottom Line: The administration of amlodipine to patients with established CAD without evidence of left ventricular dysfunction and normal house pressure, with or without treatment, may convert into the risk of coronary revascularization or hospitalization for renewed chest pain. The current meditation does not show a clear benefit of amlodipine through the whole extent of placebo in reducing the risk of other patient-oriented issues including MI, stroke,all-cause hospitalization, or death. Therefore, the investigators simply may be measuring the general intents of amlodipine as an antianginal medication. (Level of Evidence: 1b-)

close attention Reference: Nissen SE, et al. power of antihyperten-sive agents on cardiovascular terminations in patients with coronary disease and normal kindred pressure: the CAMELOT study: a randomized controll trial. JAMA November 10 2004;292:2217-25

Used with permission from Slawson D Amlodipine for CAD and normal children pressure minimally, if at all, beneficial (CAMELOT). Accessed online December 28 2004 at: http://InfoPOEMs.com.

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