Amlodipine Tied to Better Long-Term Stroke Recovery Than Nifedipine

Patients prescribed amlodipine at discharge after ischemic stroke or transient ischemic attack (TIA) had better 5-year functional outcomes than those prescribed nifedipine, according to an observational registry study published in PLOS Medicine.

The investigators noted that direct comparative evidence is scarce for the 2 calcium channel blockers most commonly prescribed in this population. Using the Third China National Stroke Registry, which enrolled consecutive adults with ischemic stroke or TIA at 201 hospitals in 22 provinces from 2015 to 2018, they included 2,859 patients with a prestroke modified Rankin Scale (mRS) score of 0 who were discharged on amlodipine or nifedipine monotherapy. Inverse probability of treatment weighting was used to balance baseline characteristics.

The amlodipine group had significantly lower 5-year mRS scores than the nifedipine group (odds ratio [OR], 0.76; 95% CI, 0.65-0.89). An mRS score above 0 at 5 years, indicating persistent functional deficits, occurred in 51.76% of amlodipine users vs 59.74% of nifedipine users (OR, 0.71; 95% CI, 0.61-0.83). Amlodipine was also associated with lower 1-year mRS scores, and the results were consistent across sensitivity analyses.

Stroke recurrence and 5-year all-cause mortality did not differ significantly between the groups.

The authors cited limitations, including the observational design, reliance on registry data, a relatively high 5-year loss-to-follow-up rate, and possible unmeasured confounders such as drug doses and blood pressure changes during follow-up. They concluded that amlodipine may be associated with improved functional recovery compared with nifedipine and that randomized controlled trials are warranted to confirm the findings.

Source: Li X, Xia X, Gao M, et al. Comparative effectiveness of amlodipine versus nifedipine prescribed at discharge in patients with ischemic stroke or transient ischemic attack: a nationwide 5-year follow-up registry study. PLoS Med. 2026;23(10):e1005277. doi:10.1371/journal.pmed.1005277