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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.
Insights
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.
Background:
Hypertension is present in 90% of individuals with heart failure with preserved ejection fraction (HFpEF) and is a major modifiable risk factor for the development of HFpEF. However, randomized controlled trial evidence for hypertension management in HFpEF is limited.
Methods:
In a double-blind, randomized, crossover trial, we studied the effect of amlodipine 5 to 10 mg versus metoprolol succinate 100 to 200 mg (doses previously demonstrated to have comparable antihypertensive efficacy) for 4 weeks among adults with HFpEF and hypertension, without contraindications to initiating or withholding either drug. The primary outcome was the difference in mean home systolic blood pressure (BP) during the final week of each treatment.
Results:
The mean age of the 50 enrolled participants was 72±9 years, 34 (68%) were female, 33 (66%) were of Black race, mean blood pressure was 144±15/78±9 mm Hg, and 23 (46%) were receiving β-blockers before enrollment. Compared with metoprolol, systolic BP was 4 (95% CI, -7 to -1; P=0.017) mm Hg lower with amlodipine. In addition, peak oxygen uptake during exercise was 1.2 (95% CI, 0.3-2.0; P=0.008) mL/min per kg higher, physical activity was 0.1 (95% CI, 0.01-0.1; P=0.019) metabolic equivalents of task/d higher, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) was 200 (95% CI, -291 to -109; P<0.0001) pg/mL lower with amlodipine versus metoprolol. There was no significant difference in septal E/e', myocardial strain, or systemic vasodilatory reserve. The frequency and severity of adverse events were similar across treatments.
Conclusions:
Our findings support the use of dihydropyridine calcium channel blockers as a preferred alternative to β-blockers for the management of hypertension in HFpEF.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04434664.
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