---
title: "Amlodipine versus nifedipine after ischemic stroke/TIA: 5-year functional outcomes"
id: "plos-medicine-0-comparative-effectiveness-of-amlodipine-versus-nifedipine-prescribed-at"
canonical_url: "https://medichelpline.com/clinical-feed/plos-medicine-0-comparative-effectiveness-of-amlodipine-versus-nifedipine-prescribed-at"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PLOS Medicine"
source_url: "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277"
published_at: "2026-10-12T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Amlodipine versus nifedipine after ischemic stroke/TIA: 5-year functional outcomes
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-medicine-0-comparative-effectiveness-of-amlodipine-versus-nifedipine-prescribed-at
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PLOS Medicine
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277)
- **Published At:** 2026-10-12T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- Observational analysis used the Third China National Stroke Registry (CNSR-III) to compare discharge prescriptions of **amlodipine** and **nifedipine** in adults with ischemic stroke or transient ischemic attack (TIA). - Investigators applied inverse probability of treatment weighting (IPTW) to balance baseline covariates including age, sex, body mass index, admission systolic blood pressure and onset date. - After weighting, 2,859 patients contributed to the primary analysis: 1,847 in the amlodipine group and 1,058 in the nifedipine group. - The primary endpoint was the distribution of the **modified Rankin Scale (mRS)** score at 5 years; the team used ordinal logistic regression to estimate odds ratios (OR) with 95% confidence intervals. - Data indicated lower 5-year mRS scores in the amlodipine group versus nifedipine (OR 0.76, 95% CI 0.65–0.89; p 0 at 5 years compared with nifedipine users (51.76% vs 59.74%; OR 0.71, 95% CI 0.61–0.83; p < 0.001). - Sensitivity analyses produced consistent direction and magnitude of effect. - The authors listed primary limitations: observational design, reliance on registry data, and relatively high loss to follow-up at 5 years. - The study team concluded that **amlodipine** may be associated with improved long-term functional recovery compared with **nifedipine**, and recommended randomized controlled trials to verify causality.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosmedicine%2Farticle%3Fid%3D10.1371%2Fjournal.pmed.1005277) * * About * Browse * Publish * [](https://journals.plos.org/plosmedicine/ "PLOS Medicine") * Search [advanced search](https://journals.plos.org/plosmedicine/search) * 0 [Save](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005277#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005277#savedHeader) * 0 [Citation](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005277#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005277#citedHeader) * 20 [View](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005277#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005277#viewedHeader) * 0 [Share](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005277#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005277#discussedHeader) Open Access Peer-reviewed Research Article # 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 * Xinya Li, Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Validation, Visualization, Writing – original draft, Writing – review & editing Affiliations Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China, Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-7539-8194 ](https://orcid.org/0000-0002-7539-8194 "ORCID Registry") ⨯ * Xue Xia, Roles Data curation, Formal analysis, Methodology, Software, Validation, Visualization, Writing – review & editing Affiliations Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China, Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-1719-0598 ](https://orcid.org/0000-0002-1719-0598 "ORCID Registry") ⨯ * Meng Gao, Roles Data curation, Formal analysis, Methodology, Software, Validation, Visualization, Writing – review & editing Affiliations Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China, Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-9384-328X ](https://orcid.org/0000-0002-9384-328X "ORCID Registry") ⨯ * Qin Xu, Roles Investigation, Validation, Writing – review & editing Affiliations Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China, Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-8039-709X ](https://orcid.org/0000-0002-8039-709X "ORCID Registry") ⨯ * Yijun Zhang, Roles Investigation, Validation, Writing – review & editing Affiliations Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China, Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China ⨯ * Jing Jing, Roles Investigation, Validation, Writing – review & editing Affiliation China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-9822-5758 ](https://orcid.org/0000-0001-9822-5758 "ORCID Registry") ⨯ * Yi Zhai, Roles Investigation, Validation, Writing – review & editing Affiliation China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China ⨯ * Xia Meng , Roles Conceptualization, Project administration, Resources, Supervision, Validation, Writing – review & editing * E-mail: mengxia@ncrcnd.org.cn (XM); wanganxin@bjtth.org (AW) Affiliations Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China ⨯ * Anxin Wang Roles Conceptualization, Funding acquisition, Project administration, Resources, Supervision, Validation, Writing – review & editing * E-mail: mengxia@ncrcnd.org.cn (XM); wanganxin@bjtth.org (AW) Affiliations Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China, Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-4351-2877 ](https://orcid.org/0000-0003-4351-2877 "ORCID Registry") ⨯ # 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 * Xinya Li, * Xue Xia, * Meng Gao, * Qin Xu, * Yijun Zhang, * Jing Jing, * Yi Zhai, * Xia Meng, * Anxin Wang ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: October 12, 2026 * * [Article](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277) * [Authors](https://journals.plos.org/plosmedicine/article/authors?id=10.1371/journal.pmed.1005277) * [Metrics](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005277) * [Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005277) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pmed.1005277) * [Abstract](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#abstract0) * [Author summary](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#abstract1) * [1 Introduction](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#sec007) * [2 Methods](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#sec008) * [3 Results](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#sec016) * [4 Discussion](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#sec020) * [Supporting information](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#sec021) * [Acknowledgments](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#ack) * [References](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#references) * [Reader Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005277) * [Figures](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277) [?](https://journals.plos.org/plosmedicine/s/accepted-manuscripts#loc-early-version) ## This is an uncorrected proof. ## Abstract ### Background Amlodipine and nifedipine are the most commonly prescribed calcium channel blockers (CCB) for patients suffering from ischemic stroke or transient ischemic attack (TIA). Nevertheless, there is a scarcity of direct comparative evidence on their effectiveness. This study aimed to compare the effectiveness of amlodipine and nifedipine in patients with ischemic stroke or TIA. ### Methods and findings This observational study was based on the Third China National Stroke Registry, which recruited consecutive adult patients with ischemic stroke or TIA from 2015 to 2018. In this study, ischemic stroke or TIA patients were prescribed either amlodipine or nifedipine at discharge. The primary outcome was the distribution of modified Rankin Scale (mRS) score, which assesses functional outcomes in patients with stroke, at 5 years. The intergroup differences were examined using ordinal logistic regression, yielding odds ratios (OR) and 95% confidence intervals (CI). Patient age, gender, body mass index, systolic blood pressure at admission, and onset date were adjusted. To improve baseline characteristic balance, inverse probability of treatment weighting (IPTW) was implemented. A total of 2,859 eligible patients were included, and there were 1847 patients in the amlodipine group and 1,058 patients in the nifedipine group after IPTW. The amlodipine group demonstrated significantly lower 5-year mRS scores in comparison to the nifedipine group, with an OR of 0.76 (95% CI [0.65, 0.89]; _p_ 0 at 5 years, with an OR of 0.71 (95% CI [0.61, 0.83]; _p_ ]s and archived in Zenodo [ ]. The data that support the findings of this study are available from the data access committee of China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University ( , Email: zhaojinqing0302@mail.ccmu.edu.cn). Such requests should be initiated by researchers conducting nonprofit academic studies who have obtained formal ethical authorization. The individual-level patient data cannot be publicly deposited or fully shared due to strict Chinese health data protection regulations, institutional ethical review board requirements, and signed participant informed consent clauses that explicitly restrict open data dissemination. **Funding:** This work was supported by the National High-Level Talent Special Support Programs-Leading Talent in Scientific and Technological Innovation (to XM from ) and the High-Level Public Health Talents (xuekegugan-02-47 to AW from ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. **Competing interests:** I have read the journal’s policy and the authors of this manuscript have the following competing interests: XM reports grant from the National High-Level Talent Special Support Programs-Leading Talent in Scientific and Technological Innovation. AW reports grant from the High-Level Public Health Talents (xuekegugan-02-47). All other authors declared no competing interests for this work. **Abbreviations:** AI, artificial intelligence; BMI, body mass index; CCB, calcium channel blockers; CI, confidence intervals; CNSR-III, Third China National Stroke Registry; CT, computed tomography; DBP, diastolic blood pressure; HR, hazard ratios; HR, hazard ratios; IPTW, inverse probability of treatment weighting; IQR, with interquartile range; MRI, magnetic resonance imaging; mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; OR, odds ratios; PREVENT, Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial; PSM, propensity score matching; RCT, randomized controlled trials; RECORD, Reporting of Studies Conducted using Observational Routinely-Collected Data; SBP, systolic blood pressure; SD, standard deviation; TIA, transient ischemic attack; WHO, World Health Organization. ## 1 Introduction Globally, stroke ranks as the third leading cause of death and the fourth leading contributor to disability-adjusted life-years [[1](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#pmed.1005277.ref001),[2](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#pmed.1005277.ref002)]. Among all new stroke cases, ischemic stroke constitutes the largest proportion, accounting for 65.3% of incidents [[2](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#pmed.1005277.ref002)]. Transient ischemic attack (TIA), often regarded as a critical warning sign for ischemic stroke, underscores the urgency of addressing this condition [[3](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#pmed.1005277.ref003),[4](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#pmed.1005277.ref004)]. While considerable research advances have been achieved in acute-phase management, secondary prevention, and rehabilitation therapies, a notable proportion of patients continue to experience suboptimal functional recovery [[5](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#pmed.1005277.ref005)–[7](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#pmed.1005277.ref007)]. Given these challenges, the identification of more effective and safe therapeutic strategies in the long term has emerged as a pivotal direction to further enhance patient outcomes and reduce the disease burden, highlighting the need for continued innovation in stroke care [[8](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#pmed.1005277.ref008)]. Hypertension, as a well-established risk factor for stroke, has garnered significant attention regarding its therapeutic management [[9](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005277#pmed.1005277.ref009)]. Among antihypertensive agents, calcium channel blockers (CCB) hold a prominent
## Related Clinical Research

- [Otolin-1 lacks diagnostic discrimination for central versus peripheral acute continuous dizziness](https://medichelpline.com/clinical-feed/plos-one-9-otolin-1-for-differentiating-central-and-peripheral-causes-of-acute-continuous.md)
- [Rising national stroke incidence and deaths in Uganda, 2016–2028 forecasts](https://medichelpline.com/clinical-feed/plos-one-5-rising-stroke-burden-in-uganda-a-national-time-series-analysis-and-forecasts.md)
- [Sintilimab Plus ADT for Synchronous Prostate Adenocarcinoma and Lung Squamous Cell Carcinoma in a](https://medichelpline.com/clinical-feed/frontiers-in-immunology-7-successful-management-of-synchronous-prostate-adenocarcinoma-and-lung-squamous.md)
- [Increasing stroke risk in younger adults requires targeted prevention and updated risk assessment](https://medichelpline.com/clinical-feed/plos-medicine-0-stroke-risk-in-younger-age-groups-is-increasing-and-requires-targeted-prevention.md)
- [Access Blocked: Unable to Retrieve BMJ Open Stroke Study on Tea‑Tribe Communities in Cachar, Assam](https://medichelpline.com/clinical-feed/bmj-open-2-burden-unmet-healthcare-and-associated-disabilities-among-people-with-prevalent.md)

## Navigation
- [← Back to Neurology Feed](https://medichelpline.com/clinical-feed/neurology.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.