Nav: Home

Commonly used heart drug associated with increased risk of sudden cardiac arrest

March 17, 2019

Lisbon, Portugal - 17 March 2019: A drug commonly used to treat high blood pressure and angina (chest pain) is associated with an increased risk of out-of-hospital sudden cardiac arrest, according to results from the European Sudden Cardiac Arrest network (ESCAPE-NET) presented today at EHRA 2019.1

Sudden cardiac arrest causes around half of cardiac deaths in Europe and one in five natural deaths. The heart stops pumping after a cardiac arrhythmia (ventricular fibrillation/tachycardia); this is lethal in minutes if untreated. ESCAPE-NET was set up to find the causes of these arrhythmias, so they can be prevented.

Dr Hanno Tan, ESCAPE-NET project leader and cardiologist, Academic Medical Centre, Amsterdam, the Netherlands, urged caution when interpreting these results. He said: "The findings need to be replicated in other studies before action should be taken by doctors or patients."

The study examined if nifedipine and amlodipine, dihydropyridines widely used for high blood pressure and angina, are linked with out-of-hospital cardiac arrest. The nifedipine doses most often used and studied in this investigation are 30 mg and 60 mg (90 mg is available but infrequently used) and the amlodipine doses are 5 mg and 10 mg. Standard practice is to start with a lower dose, then give the higher dose if blood pressure or chest pain are not sufficiently reduced.

The analysis was done using data from the Dutch Amsterdam Resuscitation Studies registry (ARREST, 2005-2011) and confirmed in the Danish Cardiac Arrest Registry (DANCAR, 2001-2014), both part of ESCAPE-NET. Patients with out-of-hospital cardiac arrest due to ventricular fibrillation/tachycardia were enrolled, plus up to five controls per patient matched for age and sex. Controls were from the Dutch PHARMO Database Network and the general population in Denmark. In total, the study included 2,503 patients and 10,543 controls in the ARREST analysis and 8,101 patients and 40,505 controls in the DANCAR analysis.

Current use of high-dose (?60 mg/day), but not low-dose (<60 mg>

The results were supported by a study in human cardiac cells. Dihydropyridines act by blocking L-type calcium channels. The laboratory study showed that at the dosages studied in this investigation, both drugs blocked these ion channels, thereby shortening the action potential of the cardiac cell. A shorter action potential can facilitate the occurrence of the fatal arrhythmias that cause sudden cardiac arrest. High-dose nifedipine (60 mg) caused more shortening of the action potential than high-dose amlodipine (10 mg).

"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 Dr Tan. "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."

These findings may be surprising given that both drugs have been in use for many years and in many patients. A possible explanation why this discovery has only been made now is that out-of-hospital cardiac arrest is very difficult to study due to its rapid course, and requires dedicated datasets collected specifically for this purpose. Until now, there were insufficient patient records to test the impact of medications. ESCAPE-NET has made this possible by linking large cohorts across Europe, including ARREST and DANCAR.

The work of ESCAPE-NET will be discussed in two sessions at EHRA 2019, highlighting the importance of working across Europe2 and advances in preventing sudden cardiac arrest during sports.3

Dr 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 behavioural (gender) reasons."

ESCAPE-NET is backed by the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC) and the European Resuscitation Council (ERC).
-end-
Authors: ESC Press Office
Tel: +33 (0)4 8987 2499
Email: press@escardio.org

Follow us on Twitter @ESCardioNews
The hashtag for the meeting is #ehra2019.

Sources of funding: Funded by the "Horizon 2020 - the Framework Programme for Research and Innovation (2014-2020)" of the European Union. Grant agreement 73 3381.

Disclosures: None.

References and notes

1The abstract 'High-dose nifedipine use is associated with increased risk of out-of-hospital cardiac arrest: multi-country case-control study' will be presented during the Young EP poster session - Young meets Experienced on Sunday March 17 at 08:30 to 18:00 WET (GMT) in the Poster Area.

2The session Sudden cardiac arrest - European perspectives and solutions takes place on Monday 18 March at 14:00 to 15:30 WET (GMT) in the Coumel lecture room.

3The session Sudden cardiac death in sports activities takes place on Monday 18 March at 08:30 to 10:00 WET (GMT) in the Coumel lecture room.

About the European Heart Rhythm Association

The European Heart Rhythm Association (EHRA) is a branch of the European Society of Cardiology (ESC). Its aim is improving the quality of life and reducing sudden cardiac death by limiting the impact of heart rhythm disturbances. EHRA ensures the dissemination of knowledge and standard setting; provides continuous education, training and certification to physicians and allied professionals involved in the field of cardiac arrhythmias with a special focus on Atrial Fibrillation (AF) and Electrophysiology (EP). EHRA releases international consensus documents and position papers, it is a source of high quality, unbiased, evidence based, scientific information that promotes the quality of care for patients with AF, and for, has also dedicated a website for patients "afibmatters.org".

About the EHRA Congress

EHRA 2019 is the annual congress of the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC).

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

Information for journalists attending EHRA 2019

EHRA 2019 will be held 17 to 19 March at the Lisbon Congress Centre (CCL) in Lisbon, Portugal. Explore the scientific programme.
  • To register on-site please bring a valid press card or appropriate letter of assignment with proof of three recent published articles (cardiology or health-related, or referring to a previous ESC Event).
  • Press registration is not available to industry or its public relations representatives, event management, marketing or communications representatives.


European Society of Cardiology

Related Blood Pressure Articles:

Do you really have high blood pressure?
A study by researchers at the University of Montreal Hospital Research Centre (CRCHUM) shows that more than half of family doctors in Canada are still using manual devices to measure blood pressure, a dated technology that often leads to misdiagnosis.
Why do we develop high blood pressure?
Abnormally high blood pressure, or hypertension, may be related to changes in brain activity and blood flow early in life.
For some, high blood pressure associated with better survival
Patients with both type 2 diabetes and acute heart failure face a significantly lower risk of death but a higher risk of heart failure-related hospitalizations if they had high systolic blood pressure on discharge from the hospital compared to those with normal blood pressure, according to a study scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session.
$9.4 million grant helps scientists explore how cell death from high blood pressure fuels even higher pressure
It's been known for decades that a bacterial infection can raise your blood pressure short term, but now scientists are putting together the pieces of how our own dying cells can fuel chronically high, destructive pressure.
Blood pressure diet improves gout blood marker
A diet rich in fruits, vegetables, low-fat dairy and reduced in fats and saturated fats (the DASH diet), designed decades ago to reduce high blood pressure, also appears to significantly lower uric acid, the causative agent of gout.
New tool to improve blood pressure measurement
Oxford University researchers have developed a prediction model that uses three separate blood pressure readings taken in a single consultation and basic patient characteristics to give an adjusted blood pressure reading that is significantly more accurate than existing models for identifying hypertension.
Blood vessels sprout under pressure
It is blood pressure that drives the opening of small capillaries during angiogenesis.
Better blood pressure control -- by mobile phone
An interactive web system with the help of your mobile phone can be an effective tool for better blood pressure control.
Time to reassess blood-pressure goals
High blood pressure or hypertension is a major health problem that affects more than 70 million people in the US, and over one billion worldwide.
With help from pharmacists, better blood pressure costs $22
A pharmacist-physician collaboration in primary-care offices effectively and inexpensively improved patients' high blood pressure.

Related Blood Pressure Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Setbacks
Failure can feel lonely and final. But can we learn from failure, even reframe it, to feel more like a temporary setback? This hour, TED speakers on changing a crushing defeat into a stepping stone. Guests include entrepreneur Leticia Gasca, psychology professor Alison Ledgerwood, astronomer Phil Plait, former professional athlete Charly Haversat, and UPS training manager Jon Bowers.
Now Playing: Science for the People

#524 The Human Network
What does a network of humans look like and how does it work? How does information spread? How do decisions and opinions spread? What gets distorted as it moves through the network and why? This week we dig into the ins and outs of human networks with Matthew Jackson, Professor of Economics at Stanford University and author of the book "The Human Network: How Your Social Position Determines Your Power, Beliefs, and Behaviours".