Effect of calcium channel blockers on influenza incidence: a population-based retrospective cohort study using
Takanori Imai1, Hideki Hashimoto1,2, Naoki Kanda1
1Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan.
Insights
Calcium channel blockers (CCBs) did not show a significant difference in preventing influenza compared to ACEI/ARBs in hypertensive patients. Further studies are needed to confirm CCBs
Area of Science:
- Virology and Infectious Diseases
- Cardiovascular Pharmacology
- Epidemiology and Public Health
Background:
- Laboratory studies suggest calcium channel blockers (CCBs) inhibit influenza A virus replication.
- Clinical evidence on CCB use and influenza incidence in patients is lacking.
- Hypertension management often involves CCBs or ACEI/ARBs.
Purpose of the Study:
- To investigate the association between CCB use and influenza incidence in hypertensive patients.
- To compare influenza rates in patients prescribed CCBs versus ACEI/ARBs in Japan.
Main Methods:
- Retrospective cohort study utilizing administrative claims data from Kumamoto Prefecture, Japan (2012-2016).
- Inclusion of hypertensive patients prescribed CCBs (N=360,515) and ACEI/ARBs (N=171,142).
- High-dimensional propensity-score (HD-PS) matching to control for confounding factors.
Main Results:
- 166,814 matched pairs were analyzed.
- No significant difference in influenza incidence was observed between CCB and ACEI/ARB groups post-HD-PS matching (2.4% vs 2.5%, p=0.067).
- A significantly lower influenza incidence was noted in the CCB group only in 2012.
Conclusions:
- CCB use was not associated with a significantly different influenza incidence compared to ACEI/ARB use in hypertensive patients.
- Further direct comparative studies are warranted to definitively assess CCBs' potential role in reducing influenza incidence.
- The findings highlight the need for clinical validation of in vitro observations.
Objectives:
Laboratory experiments have indicated that calcium channel blockers (CCBs) inhibit the entry and replication of influenza A virus in cells. However, no clinical studies have assessed the incidence of influenza among patients receiving CCBs. This study aimed to investigate the association between CCB use and the incidence of influenza among patients with hypertension using administrative claims data in Japan.
Design:
Retrospective cohort study.
Setting:
Administrative health insurance claims database of Kumamoto Prefecture, Japan.
Participants:
360 515 patients with hypertension (10th edition of the International Classification of Diseases code I10) who were prescribed CCBs and 171 142 patients who were prescribed angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) between 2012 and 2016.
Primary Outcome:
We compared the incidence of influenza between the CCB and ACEI/ARB groups using high-dimensional propensity-score (HD-PS) matching.
Results:
A total of 166 814 HD-PS matched pairs were obtained. Before HD-PS matching, the CCB group had a significantly lower influenza incidence than the ACEI/ARB group in the overall analysis (2.4% vs 2.5%, p=0.007; risk ratio 0.95, 95% CI 0.92 to 0.99). However, no significant difference was observed between the two groups after HD-PS matching (2.4% vs 2.5%, p=0.067; risk ratio 0.96, 95% CI 0.92 to 1.00); only in 2012 did the CCB group have a significantly lower likelihood of influenza than the ACEI/ARB group.
Conclusions:
No significant difference was observed in the influenza incidence between the CCB and ACEI/ARB groups. A direct comparative study between background-matched patients with and without CCBs is warranted to confirm the effect of CCBs on reducing the incidence of influenza.
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