Eight RCTs (n=2,034) were included in the meta-analyses. All trials used intention-to-treat analyses for safety outcomes, but only five trials used intention-to-treat analyses for efficacy outcomes. Blinding was inadequately reported in all trials. Allocation concealment was adequate in one trial. Method of randomisation was not reported in most trials. Loss to follow-up was low in all trials.
When studies were pooled, there were no significant differences in reduced blood pressure between lercanidipine and first-generation or second-generation calcium channel blockers.
Compared with first-generation drugs, lercanidipine was associated with a significant reduction in peripheral edema (RR 0.44, 95% CI 0.31 to 0.62; five RCTs), but not in flushing or headache. There were no significant differences in these outcomes between lercanidipine and second-generation drugs.
Compared with first-generation drugs, lercanidipine was associated with a significant reduction in patient withdrawals due to peripheral oedema (RR 0.24, 95% CI 0.12 to 0.47; four RCTs) or due to any adverse event (RR 0.51, 95% CI 0.33 to 0.77; five RCTs). There were no significant differences in these outcomes between lercanidipine and the second-generation drugs.
Significant heterogeneity was observed only in the outcomes of headache (I2=63.4%) when lercanidipine was compared with first-generation drugs and withdrawals due to any adverse event (I2=66.9%) when lercanidipine was compared with second-generation drugs. Sensitivity analyses did not materially affect the results.