« Back

CCBs associated with increased risk of HF relative to other hypertension therapies, findings suggest

Wednesday, August 18 2010 | Comments

---

What's This? Among patients with hypertension, those who receive treatment with calcium channel blockers (CCBs) may be more likely to develop heart failure (HF) than are those who receive treatment with other commonly prescribed therapies, according data from a recently published analysis.

Researchers conducted a systematic review of randomized controlled trials that compared CCBs with an active control (angiotensin-converting enzyme [ACE] inhibitors, angiotensin II receptor blockers (ARBs), diuretics, or beta blockers) in patients with hypertension. The analysis included 19 trials, with a total of 156,766 participants and 5,049 cases of incident HF; all included trials had more than 200 participants, provided more than six months of follow-up data and tracked cases of incident HF.

The odds ratio (OR) for HF with CCBs (vs active controls) was 1.18 (95% CI, 1.07-1.31). The results suggested moderate heterogeneity among the trials, with data from all but 4 trials yielding point estimates suggesting a higher risk of HF with CCBs than with controls.

The risk of HF remained significant when the analysis was restricted to trials comparing CCBs with ACE inhibitors or ARBs (OR, 1.21; 95% CI, 1.10-1.32) and when the analysis was restricted to trials comparing CCBs with diuretics (OR, 1.32; 95% CI, 1.04-1.66). However, CCBs were not associated with an increased risk of HF in an analysis restricted to trials that compared CCBs with diuretics and/or beta blockers (OR, 1.01; 95% CI, 0.82-1.25).

CCBs were not associated with an increased risk of incident myocardial infarction (MI) as compared with controls (OR, 0.96; 95% CI, 0.87-1.07), suggesting the increased incidence of HF with CCBs could not be explained by differences in rates of incident MI.

In subgroup analyses, the investigators assessed the risk of HF with CCBs in patients with diabetes, isolated systolic hypertension, and coronary artery disease (CAD). The risk of HF with CCBs was particularly pronounced in patients with diabetes (OR, 1.71; 95% CI, 1.21-2.41) and was also significant in patients with isolated systolic hypertension (OR, 1.18; 95% CI, 1.01-1.39), but it was not significant in patients with CAD (OR, 1.11; 95% CI, 0.91-1.36).

The authors noted that these results did not vary by type of CCB used (dihydropyridines vs nondihydropyridines).

The current data suggest "that CCBs are probably inferior to other agents in terms of offering protection against HF, despite the same magnitude of BP reduction," the researchers wrote.

However, they noted that there were limitations to their analysis, including the lack of a clear definition of HF among the included trials and a lack of data regarding the types of incident HF (systolic, diastolic, or both). In addition, the current data cannot determine whether the observed increased risk of HF was due to CCB-related increases in catecholamine, negative inotropic activity, both, or another mechanism.

As a result, the investigators cautioned that their findings should be regarded as hypothesis-generating and should be explored further in future trials. (Shibata MC, et al. Am J Cardiol 2010;106:228-235.)

Print  |  E-mail