Nifedipine and amlodipine associated with higher risk of out-of-hospital cardiac arrest
In data reported at European Heart Rhythm Association 2019 (17–19 March, Lisbon, Portugal), high doses of nifedipine and amlodipine, commonly used to treat high blood pressure and angina, increased the risk of out-of-hospital sudden cardiac arrest.
In new research from the European Sudden Cardiac Arrest network (ESCAPE-NET), commonly prescribed medicines for the treatment of chest pain and blood pressure were found to increase the risk of out-of-hospital sudden cardiac arrest. Data from the Dutch Amsterdam Resuscitation Studies registry (ARREST, 2005–2011) and confirmed in the Danish Cardiac Arrest Registry (DANCAR, 2001–2014) was assessed in the study.
“Nifedipine and amlodipine are often used by many cardiologists and other physicians, and the choice often depends on the prescriber’s preference and personal experience,” said Hanno Tan, ESCAPE-NET project leader and cardiologist, Academic Medical Centre (Amsterdam, the Netherlands).
Tan said: “As a European consortium we can validate our findings in different populations, and we bring together different expertise. For example, sudden cardiac arrest during sports is 19 times more common in men than women and the network enables us to comprehensively evaluate the potential biological (sex) and behavioral (gender) reasons.”
When prescribed at doses of more than 60mg, nifedipine increased the rate of out-of-hospital cardiac arrest with an odds ratio of 1.5 in ARREST and 2.0 in DANCAR. This dose of nifedipine was also associated with an increased risk of out-of-hospital cardiac arrest when compared with any dose of amlodipine, with odds ratios of 2.3 and 2.2 in the ARREST and DANCAR registries, respectively. However, there was no risk associated with amlodipine.
Although these drugs have been in use for many years, there has been too few patient records to adequately assess the impact of particular medicines. Out-of-hospital cardiac arrest is also difficult to study due to its rapid course.
Concluding, Tan explained: “Both drugs are generally considered to be equally effective and safe and neither has been associated with sudden cardiac arrest. This study suggests that high-dose nifedipine may increase the risk of sudden cardiac arrest due to fatal cardiac arrhythmia while amlodipine does not. If these findings are confirmed in other studies, they may have to be taken into account when the use of either drug is considered.”