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Calcium Channel Blockade Versus β-Blockade for Hypertension in Heart Failure With Preserved Ejection Fraction: A
Jordana B Cohen1,2, Alavi Hossain1,3, Jesse Chittams2,3
1Renal-Electrolyte and Hypertension Division (J.B.C., A.H., R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Hypertension (Dallas, Tex. : 1979)
|May 15, 2026
Summary
Amlodipine significantly lowered systolic blood pressure in patients with heart failure with preserved ejection fraction (HFpEF). This study suggests dihydropyridine calcium channel blockers are a preferred hypertension treatment for HFpEF patients.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Hypertension affects 90% of patients with heart failure with preserved ejection fraction (HFpEF).
- Hypertension is a key modifiable risk factor for HFpEF development.
- Limited randomized controlled trial evidence exists for hypertension management in HFpEF.
Purpose of the Study:
- To compare the efficacy of amlodipine versus metoprolol succinate in managing hypertension in patients with HFpEF.
- To evaluate the impact of amlodipine and metoprolol on systolic blood pressure and other clinical outcomes in HFpEF.
Main Methods:
- A double-blind, randomized, crossover trial involving 50 adults with HFpEF and hypertension.
- Participants received amlodipine (5-10 mg) or metoprolol succinate (100-200 mg) for 4 weeks each.
- Primary outcome: difference in mean home systolic blood pressure during the final week of each treatment.
Main Results:
- Amlodipine resulted in a 4 mm Hg lower systolic blood pressure compared to metoprolol (P=0.017).
- Amlodipine improved peak oxygen uptake and physical activity levels.
- Amlodipine significantly reduced NT-proBNP levels (P<0.0001) with similar adverse event rates.
Conclusions:
- Dihydropyridine calcium channel blockers, like amlodipine, are a preferred alternative to beta-blockers for hypertension management in HFpEF.
- The findings support amlodipine's role in improving key clinical markers in HFpEF patients.
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