Alessandra Bettiol1,2, Ersilia Lucenteforte3, Alfredo Vannacci1, Niccolò Lombardi1, Graziano Onder4, Nera Agabiti5, Cristiana Vitale6, Gianluca Trifirò7, Giovanni Corrao8, Giuseppe Roberto9, Alessandro Mugelli1, Alessandro Chinellato2. 1. Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, viale Gaetano Pieraccini, 6, 50139, Florence, Italy. 2. Local Health Unit n.2 Marca Trevigiana, Veneto Region, Treviso, Italy. 3. Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, viale Gaetano Pieraccini, 6, 50139, Florence, Italy. ersilia.lucenteforte@unifi.it. 4. Department of Geriatrics, Neurosciences, and Orthopaedics, Catholic University of Medicine, Rome, Italy. 5. Department of Epidemiology, Lazio Regional Health Service, Rome, Italy. 6. Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy. 7. Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy. 8. Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy. 9. Regional Agency for Healthcare Services of Tuscany, Epidemiology Unit, Florence, Italy.
Abstract
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.
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.
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