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

Background: Hypertension is common in patients with aortic stenosis (AS) and optimal blood pressure (BP) control is advised to reduce arterial load and cardiovascular events. Whether calcium channel blockers (CCB) are safe is not known. Methods: This was a retrospective analysis of 314 patients (age 65 ± 12 years, 68% men) with moderate or severe asymptomatic AS. Hypertension was defined from a history of hypertension, past or current antihypertensive treatment or a BP at the baseline clinic visit >140/90 mmHg. All patients underwent an exercise treadmill test (ETT) and echocardiography. Results: The prevalence of hypertension was 73.6%, and 65% took antihypertensive treatment. Patients who used a CCB (25%) (CCB+) were older, more likely to have hypercholesterolemia and coronary artery disease, and had higher systolic BP, stroke work, left ventricular mass compared to CCB-patients (all p < 0.05). During the baseline ETT, CCB+ patients achieved a lower peak heart rate, a shorter exercise time and were more likely to have a blunted BP response compared to CCB- patients (p < 0.05). Event-free survival was significantly lower in CCB+ than CCB- patients (all-cause mortality 16 [20.3%] versus 13 [5.6%]; p < 0.001). In a multivariable Cox regression model, CCB+ was associated with a 7-fold increased hazard ratio (HR) for all-cause mortality (HR 7.09; 95% CI 2.15–23.38, p = 0.001), independent of age, hypertension, diabetes, left ventricular ejection fraction, and aortic valve area. Conclusion: The use of CCB was associated with an adverse effect on treadmill exercise and reduced survival in asymptomatic patients with moderate or severe AS.