The Comparative Effects of S-Amlodipine Versus Racemic Amlodipine on Long-Term Cardiovascular Outcomes in Subjects With Hypertension: A Nationwide Population-Based Cohort Study

Although S-amlodipine is known to have similar effects in lowering blood pressure and fewer side effects than amlodipine (= mixture of S- and R-amlodipine), there are no available data on its impact on long-term cardiovascular prognosis. This retrospective cohort study analyzed claims data from Korean subjects with hypertension treated with either S-amlodipine or amlodipine from 2010 to 2020. Subjects with history of cardiovascular disease or stroke were excluded. The composite end points of all-cause death, myocardial infarction, and stroke as 3P-major adverse cardiovascular event (MACE) and the composite end points of 3P-MACE and heart failure hospitalization as 4P-MACE were assessed. The study included 1:2 propensity score-matched groups of subjects taking S-amlodipine (n = 15,709) and amlodipine (n = 29,951). The mean clinical follow-up duration was 4.9 ± 0.3 years (median 5.0 years). After adjusting for clinical factors, S-amlodipine was associated with a reduced incidence of 3P-MACE (adjusted hazard ratio, 0.87; 95% confidence interval, 0.81-0.94; P < 0.001), and 4P-MACE (adjusted hazard ratio, 0.86; 95% confidence interval, 0.80-0.93; P < 0.001) compared with amlodipine. The better impact of S-amlodipine than amlodipine on 3P-MACE and 4P-MACE was also observed in the subgroup analysis based on various clinical factors. S-amlodipine showed better adherence than amlodipine (proportions of days covered ≥0.8: 96.7% vs. 91.8%; P < 0.001). In conclusion, S-amlodipine seems to potentially reduce the risk of long-term MACE compared with amlodipine in patients with hypertension who have no history of cardiovascular disease. However, these findings should be interpreted with caution and confirmed through further prospective studies.