Secondary hypertension (OR 2.00; 95% CI 1.66-2.42), allergies, female sex, and higher BMI were identified as independent predictors of calcium channel blocker intolerance in hypertensive outpatients.
Cohort (n=14,629)
No
What are the prevalence and predictors of intolerance to calcium channel blockers in hypertensive outpatients?
CCB intolerance affects 15.7% of hypertensive patients and is independently predicted by female sex, allergies, secondary hypertension, and higher BMI, highlighting factors that can help personalize antihypertensive therapy.
Odds Ratio: 2 (95% CI 1.66–2.42)
Objective: Calcium channel blockers (CCBs) are a key treatment for hypertension, but their use can lead to side effects, which may reduce adherence and necessitate alternative therapies. The aim of our study is to evaluate intolerance to CCBs and identify related independent clinical predictors in an Italian hypertensive outpatient cohort. Design and method: We retrospectively analysed 14629 hypertensives evaluated at our tertiary care hypertension centre from January 2005 to April 2025. Results: Among 14629 hypertensives, 8004 (54.71%) were treated with CCBs (56% with amlodipine). CCB intolerance was observed in 2299 patients (15.7%), mainly to amlodipine (34,02%). Intolerants were more often female (57.1% vs 48.4%, p<0.001), allergic (33.4% vs 25.9%, p<0.001), with secondary hypertension (10.9% vs 6.5%, p<0.001), low education (45.4% vs 39.2%, p<0.001), higher body mass index BMI (27 vs 26, p<0.001), and showed more visits, medications and diagnostic tests (p<0.001). Multivariate analysis identified female (OR 1.30 1.15–1.46), allergy (OR 1.50 1.32–1.69), secondary hypertension (OR 2.00 1.66–2.42), low education (OR 1.10 1.04–1.18), systolic blood pressure (OR 1.01 1.01–1.01) and BMI (OR 1.03 1.01–1.04) as independent predictors of CCB intolerance. Among 1527 intolerants to amlodipine, 16.2% were also intolerant to other CCBs, 36.9% switched to another CCB and 30.8% tolerated the switch. Compared to tolerants, those intolerant amlodipine were more often female (53.8% vs 38.3%, p<0.001), allergic (32.3% vs 22.6%, p<0.001) and had secondary hypertension (10.9% vs 8.4%, p=0.004), with a higher number of visits, medications and diagnostic tests. A multivariate analysis on amlodipine intolerance showed the same results of those of CCB intolerance. No significant differences in blood pressure control were found between amlodipine and other CCB treatments, despite patients assuming amlodipine reached blood pressure control with fewer drugs (p<0,001). Conclusions: CCB intolerance is linked to female sex, allergies, secondary hypertension, and higher BMI. These factors can help to personalize therapy. Switching to other CCBs may reduce the side effects despite being equally effective in terms of blood pressure control.
Ponsa et al. (Fri,) conducted a cohort in Hypertension (n=14,629). Clinical predictors (secondary hypertension, allergies, female sex, higher BMI) vs. Absence of these risk factors was evaluated on Calcium channel blocker (CCB) intolerance (OR 2.00, 95% CI 1.66-2.42). Secondary hypertension (OR 2.00; 95% CI 1.66-2.42), allergies, female sex, and higher BMI were identified as independent predictors of calcium channel blocker intolerance in hypertensive outpatients.