Calcium Channel Blockers in Secondary Cardiovascular Prevention and Risk of Acute Events: Real-World Evidence from Nested Case–Control Studies on Italian Hypertensive Elderly

• Published in: Clinical drug investigation 2017-12, Vol.37 (12), p.1165-1174
• Main Authors: Bettiol, Alessandra, Lucenteforte, Ersilia, Vannacci, Alfredo, Lombardi, Niccolò, Onder, Graziano, Agabiti, Nera, Vitale, Cristiana, Trifirò, Gianluca, Corrao, Giovanni, Roberto, Giuseppe, Mugelli, Alessandro, Chinellato, Alessandro
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antihypertensive Agents - therapeutic use; Calcium Channel Blockers - adverse effects; Calcium Channel Blockers - therapeutic use; Cardiovascular disease; Cardiovascular Diseases - prevention & control; Case-Control Studies; Cohort Studies; Female; Health risk assessment; Humans; Hypertension - drug therapy; Internal Medicine; Male; Medicine & Public Health; Mortality; Odds Ratio; Older people; Original Research Article; Pharmacology/Toxicology; Pharmacotherapy; Risk; Secondary Prevention; Stroke
• ISSN: 1173-2563; 1179-1918
• DOI: 10.1007/s40261-017-0576-2

Background and Objectives Antihypertensive treatment with calcium channel blockers (CCBs) is consolidated in clinical practice; however, different studies observed increased risks of acute events for short-acting CCBs. This study aimed to provide real-world evidence on risks of acute cardiovascular (CV) events, hospitalizations and mortality among users of different CCB classes in secondary CV prevention. Methods Three case–control studies were nested in a cohort of Italian elderly hypertensive CV-compromised CCBs users. Cases were subjects with CV events ( n  = 25,204), all-cause hospitalizations ( n  = 19,237), or all-cause mortality ( n  = 17,996) during the follow-up. Up to four controls were matched for each case. Current or past exposition to CCBs at index date was defined based on molecule, formulation and daily doses of the last CCB delivery. The odds ratio (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression models. Results Compared to past users, current CCB users had significant reductions in risks of CV events [OR 0.88 (95% CI: 0.84–0.91)], hospitalization [0.90 (0.88–0.93)] and mortality [0.48 (0.47–0.49)]. Current users of long-acting dihydropyridines (DHPs) had the lowest risk [OR 0.87 (0.84–0.90), 0.86 (0.83–0.90), 0.55 (0.54–0.56) for acute CV events, hospitalizations and mortality], whereas current users of short-acting CCBs had an increased risk of acute CV events [OR 1.77 (1.13–2.78) for short-acting DHPs; 1.19 (1.07–1.31) for short-acting non-DHPs] and hospitalizations [OR 1.84 (0.96–3.51) and 1.23 (1.08–1.42)]. Conclusions The already-existing warning on short-acting CCBs should be potentiated, addressing clinicians towards the choice of long-acting formulations.