Calcium channel blockers in hypertensive heart failure: mortality outcomes and subgroup analysis

Introduction The past decade has seen significant advancements in the pharmacological management of heart failure (HF). Although hypertension (HTN) is common among HF patients, the role of calcium channel blockers (CCB) in this population remains unclear. Purpose To assess the impact of CCB use on survival outcomes in HF patients and explore its potential benefits and risks. Methods A retrospective cohort study was conducted on 21,809 HF patients treated between January 2014 and August 2024 at a tertiary center. Patients were categorized based on CCB use, and inverse probability treatment weighting (IPTW) was applied to adjust for baseline differences. One- and two-year survival was assessed using binary logistic regression, and overall survival was analyzed using Kaplan-Meier methods. Ethical approval was obtained from the Institutional Review Board. Results The cohort included 6,481 CCB users and 15,328 non-users (median age 74 years [IQR 76 ± 12 vs. 73 ± 14, p < 0.01]). Baseline characteristics differed significantly between groups. Over a median follow-up of 3.6±3 years, 10,168 (46%) patients died. After IPTW, the pseudo-population consisted of 23,073 patients with a median age of 73±11 of which 11,664 (50.5%) were in the CCB group with balanced baseline characteristics. Following IPTW, CCB use demonstrated no significant impact on overall survival (HR 1.01, 95% CI 0.97–1.05, p = 0.95). Similar one- and two-year mortality rates were observed (p > 0.4 for all). Comparative analysis of other antihypertensive agents showed that alpha-blockers were associated with a 12% increased mortality risk (95% CI 1.01–1.24, p = 0.04), whereas renin-angiotensin-aldosterone system inhibitors (RAASi) were associated with an 11% reduced risk of death (95% CI 0.83–0.95, p = 0.01) (Figure). Subgroup analysis revealed no significant interaction between CCB use and comorbidities, except in patients with GFR < 30 ml/min, where CCB was associated with better survival (HR 0.85, 95% CI 0.76–0.95, p < 0.01). Conclusions CCB use appears to be safe in contemporary hypertensive HF patients, with no significant impact on mortality. However, in patients with severe renal impairment (GFR < 30 ml/min), CCB use was associated with improved survival. Randomized clinical trials are necessary to validate our findings.Adjusted IPTW Kaplan Meier Graphs Drugs