Calcium channel blockers and the risk of all-cause mortality and severe illness in patients with COVID-19

Background: Hypertension induces systemic inflammation, but its impact on the outcome of infectious diseases like tuberculosis (TB) is unknown. Calcium channel blockers (CCB) improve TB treatment outcomes in pre-clinical models, but their effect in patients with TB remain unclear. Methods: This retrospective cohort study, including all patients > 18 years receiving treatment for culture-confirmed, drug-sensitive TB from 2000 to 2016 at the National Taiwan University Hospital, assessed the association of hypertension and CCB use with all-cause and infection-related mortality during the first 9 months of TB treatment, as well as sputum-smear microscopy and sputum-culture positivity at 2 and 6 months. Results: 1052 of the 2894 patients (36.4%) had hypertension. Multivariable analysis revealed that hypertension was associated with increased mortality due to all causes (HR 1.57, 95% confidence interval[CI], 1.23-1.99) and infections (HR 1.87, 95%CI, 1.34-2.6), but there was no statistical difference in microbiological outcomes when stratified based on hypertensive group. Dihydropyridine-CCB (DHP-CCB) use was associated with reduced all-cause mortality (HR 0.67, 95%CI: 0.45-0.98) only by univariate Cox regression. There was no association between DHP-CCB use and infection-related mortality (HR 0.78, 95%CI: 0.46-1.34) or microbiological outcomes in univariate or multivariate regression analyses. Conclusions: Patients with hypertension have increased all-cause mortality and infection-related mortality during the 9 months following TB treatment initiation. DHP-CCB use may lower all-cause mortality in TB patients with hypertension. The presence of hypertension or the use of CCB did not result in a significant change in microbiological outcomes. Keywords: Tuberculosis, hypertension, calcium channel blockers, mortality, treatment outcomes

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P2650Antihypertensive treatment with calcium channel blockers in patients with moderate or severe aortic stenosis: relationship with all-cause mortality

European Heart Journal ◽

10.1093/eurheartj/ehz748.0971 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Saeed ◽

G Mancia ◽

R Rajani ◽

D Parkin ◽

J B Chambers

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Calcium Channel ◽

Calcium Channel Blockers ◽

Cox Regression ◽

Channel Blockers ◽

Aortic Valve Area ◽

Stroke Work ◽

All Cause Mortality ◽

Valve Area

Abstract Background Hypertension is prevalent in patients with aortic stenosis (AS) and optimal blood pressure (BP) control is advised to reduce arterial load and avoid cardiovascular events. Whether calcium channel blockers (CCB) are safe is not known. Methods A total of 314 patients (age 65±12 y, 68% men) with moderate or severe asymptomatic AS were included. Results The prevalence of hypertension was 73.6%, and 65% took antihypertensive treatment. Patients who used a CCB (25%) (CCB+) were older, had higher clinic systolic BP, were more likely to have hypercholesterolemia and coronary artery disease (CAD), and to use a diuretic or alpha blocker compared to CCB- patients (all p<0.05) (Table). During the baseline ETT, patients who used a CCB achieved a lower peak heart rate, a shorter exercise time and were more likely to have a blunted BP response compared to those who did not use a CCB (all p<0.05) (Table). Event-free survival was significantly lower in CCB+ than CCB- patients (Fig) (all-cause mortality 16 [20.3%] versus 13 (5.6%); p<0.001). In a multivariable Cox regression model, CCB+ was associated with a 6.8-fold increased hazard ratio (HR) for all-cause mortality (HR 6.77 95% CI 1.66–27.54, p=0.008), independent of age, gender, systolic BP, hypertension, diabetes, CAD, hypercholesterolemia and aortic valve area. Table 1. Baseline characteristics of patients CCB− (n=234) CCB+ (n=80) p Age, y 64±12 70±10 <0.001 CAD, % 45 66 0.006 Hypercholesterolemia, % 62 78 0.015 Clinic systolic BP, mmHg 139±19 150±17 <0.001 Left atrial diameter, cm 3.7±0.7 3.9±0.6 0.007 LV end-diastolic diameter, cm 4.5±0.7 4.8±0.6 0.002 LV mass index, g/m2.7 50±17 57±17 0.007 Aortic valve area, cm2 0.94±0.22 0.93±0.22 0.716 LV stroke work, g-m/bmp 155±46 175±69 0.046 Peak HR at baseline ETT, bmp 138±24 120±25 <0.001 Blunted BP response, % 33 49 0.013 Exercise duration, min 10.1±4.5 8.3±3.7 0.001 Double Product, mmHg·bmp 1.85±0.43 2.08±0.54 <0.001 Figure 1 Conclusion The use of calcium channel blockers was associated with an adverse effect on treadmill exercise and reduced survival in apparently asymptomatic patients with moderate or severe AS. Acknowledgement/Funding None

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Effect of Statins and Calcium Channel Blockers on All-Cause Mortality and Cardiovascular and Cerebrovascular Disease Mortality in 958 Chinese Hospitalized Patients with Peripheral Arterial Disease after 13 Months of Follow-up

JOURNAL OF HEALTH SCIENCE ◽

10.1248/jhs.53.226 ◽

2007 ◽

Vol 53 (2) ◽

pp. 226-233 ◽

Cited By ~ 3

Author(s):

Xiankai Li ◽

Jue Li ◽

Thach Nguyen ◽

Mingzhong Zhao ◽

Liqiang Zheng ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Cerebrovascular Disease ◽

Calcium Channel ◽

Calcium Channel Blockers ◽

Arterial Disease ◽

Channel Blockers ◽

Disease Mortality ◽

All Cause Mortality ◽

Peripheral Arterial

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The Impact of Hypertension and Use of Calcium Channel Blockers on Tuberculosis Treatment Outcomes

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1446 ◽

2020 ◽

Author(s):

Vignesh Chidambaram ◽

Akshay Gupte ◽

Jann-Yuan Wang ◽

Jonathan E Golub ◽

Petros C Karakousis

Keyword(s):

Calcium Channel ◽

Treatment Outcomes ◽

Calcium Channel Blockers ◽

Cox Regression ◽

Multivariable Analysis ◽

Channel Blockers ◽

Tb Treatment ◽

All Cause Mortality ◽

The Impact ◽

Related Mortality

Abstract Background Hypertension induces systemic inflammation, but its impact on the outcome of infectious diseases like tuberculosis (TB) is unknown. Calcium channel blockers (CCB) improve TB treatment outcomes in pre-clinical models, but their effect in patients with TB remain unclear. Methods This retrospective cohort study, including all patients > 18 years receiving treatment for culture-confirmed, drug-sensitive TB from 2000 to 2016 at the National Taiwan University Hospital, assessed the association of hypertension and CCB use with all-cause and infection-related mortality during the first 9 months of TB treatment, as well as sputum-smear microscopy and sputum-culture positivity at 2 and 6 months. Results 1052 of the 2894 patients (36.4%) had hypertension. Multivariable analysis revealed that hypertension was associated with increased mortality due to all causes (HR 1.57, 95% confidence interval[CI], 1.23-1.99) and infections (HR 1.87, 95%CI, 1.34-2.6), but there was no statistical difference in microbiological outcomes when stratified based on hypertensive group. Dihydropyridine-CCB (DHP-CCB) use was associated with reduced all-cause mortality (HR 0.67, 95%CI: 0.45-0.98) only by univariate Cox regression. There was no association between DHP-CCB use and infection-related mortality (HR 0.78, 95%CI: 0.46-1.34) or microbiological outcomes in univariate or multivariate regression analyses. Conclusions Patients with hypertension have increased all-cause mortality and infection-related mortality during the 9 months following TB treatment initiation. DHP-CCB use may lower all-cause mortality in TB patients with hypertension. The presence of hypertension or the use of CCB did not result in a significant change in microbiological outcomes.

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