Calcium channel blockers linked to lower mortality in heart failure with advanced kidney disease

Design

Retrospective single-centre cohort with Cox regression and inverse probability treatment weighting

Population

1,835 patients with heart failure and eGFR of 30 mL/min/1.73 m² or less; 988 on calcium channel blockers

Primary outcome

All-cause mortality

Effect

Unadjusted HR 0.83 (95% CI 0.74 to 0.93); IPTW-adjusted HR 0.85 (0.73 to 0.99)

A single tertiary centre's registry cohort included 1,835 consecutive patients with heart failure and an eGFR of 30 or less. Of these, 988 (53.8%) were taking a calcium channel blocker at baseline, 45% of them a dihydropyridine. Median follow-up was 1.68 years, and 69.7% died.

Use of a calcium channel blocker was associated with lower all-cause mortality: unadjusted hazard ratio 0.83 (95% CI 0.74 to 0.93) and 0.85 (0.73 to 0.99) after inverse probability weighting. The association was reported for non-dihydropyridine agents but not significant for dihydropyridines. It was consistent across heart failure phenotypes, diabetes and hypertension.

The finding is hypothesis-generating. Treatment was not randomised, and sicker patients may have been prescribed or spared these drugs for reasons that were not measured. Non-dihydropyridine blockers are generally avoided in heart failure with reduced ejection fraction, and nothing here supports changing that.

• Do not start a calcium channel blocker for survival on this evidence
• Where blood pressure needs another drug in this group, this study offers some reassurance on dihydropyridine safety
• Keep guideline-directed heart failure therapy as the priority
• Avoid non-dihydropyridine agents in reduced ejection fraction, as usual
• Review doses of all antihypertensives against eGFR and symptoms

Why it matters

Evidence for blood pressure treatment in this high-mortality group is thin, so signals like this will be quoted.

Don't overread it

It is a retrospective single-centre association, and it does not alter the guidance against non-dihydropyridine blockers in reduced ejection fraction.

The statistics, in plain English

A hazard ratio of 0.85 with a lower limit of 0.73 and an upper limit of 0.99 only just excludes no effect. Inverse probability weighting balances measured characteristics between groups, but it cannot balance what was not measured, such as frailty or reasons for prescribing.

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