Blood pressure lowering effect of calcium channel blockers on perioperative hypertension A systematic review and meta-analysis

Background: Acute perioperative hypertension has been associated with poor outcomes of surgery, and the role of calcium channel blockers (CCB) on controlling perioperative blood pressure (BP) remains controversial. Thus, this meta-analysis was designed to assess the efficacy and safety of CCB in treating perioperative hypertension compared with other antihypertensive agents. Methods: PubMed, Medline, Cochrane, and EMABSE databases was systematically searched up to January 2018 for randomized control trials (RCTs) or other control studies comparing the efficacy of CCB versus other antihypertensive medicines for perioperative hypertension modulation. The efficacy and safety of CCB in treating perioperative hypertension were assessed through pooling mean difference (MD) with its 95% confidence interval (CI) or risk ratio (RR) with its 95% CI. Results: In total, 14 studies were included in the meta-analysis. There is no significant difference regarding successful treatment (RR=2.64, 95% CI: 0.95, 7.29; I-2=97%, P<.05), systolic blood pressure (SBP) (MD=-7.05, 95% CI: -16.27, 2.17; I-2=78%, P<.05), overall adverse events (RR=0.88, 95% CI: 0.66, 1.16; I-2=54%, P=.02), atrial fibrillation (RR=0.80, 95% CI: 0.60, 1.07; I-2=32%, P=.20) and heart rates (MD=-1.05, 95% CI: -7.81, 5.71; I-2=84%, P<.05) between patients treated by CCB and other drugs. In the subgroup analysis, statistical significance can be observed regarding successful treatment (RR=3.46, 95% CI: 1.67, 7.18; I-2=84%, P<.05) and postoperative SBP (MD=-9.98, 95% CI: -20.03, 0.08; I-2=97%, P<.05) in the RCTs subgroup. Conclusion: CCB was highly effective and well tolerated for treating perioperative hypertension.