Comparison of beta-blockers vs calcium channel blockers in heart failure with preserved ejection fraction

doi:10.4330/wjc.v17.i12.115254

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Dec 26, 2025 (publication date) through Dec 24, 2025

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World Journal of Cardiology

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1949-8462

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Cardiol. Dec 26, 2025; 17(12): 115254
Published online Dec 26, 2025. doi: 10.4330/wjc.v17.i12.115254

Comparison of beta-blockers vs calcium channel blockers in heart failure with preserved ejection fraction

Moaz Mansoor, Faisal Nabi Depar, Hafiz Usama Talha, Haroon Ur Rashid, Ahmad Ashraf, Muhammad Nouman, Mohammad Abbas, Maaz Tariq Abbasi, Ali Sher

Moaz Mansoor, Department of Medicine, CMH Lahore Medical College, Lahore 54810, Punjab, Pakistan

Faisal Nabi Depar, Department of Medicine, People’s University of Medical & Health Sciences for Women, Shaheed Benazirabad, Nawabshah 67480, Sindh, Pakistan

Hafiz Usama Talha, Department of Cardiology, Islamic International Medical College, Rawalpindi 00666, Punjab, Pakistan

Haroon Ur Rashid, Department of Neurology, Lady Reading Hospital, Peshawar 25000, Khyber Pakhtunkhwa, Pakistan

Ahmad Ashraf, Department of Medicine, Arif Memorial Teaching Hospital, Lahore 54600, Pakistan

Muhammad Nouman, Department of Internal Medicine, Okara Patient Welfare Association, Okara 56300, Punjab, Pakistan

Mohammad Abbas, Department of Medicine, Khyber Medical College, Peshawar 25120, Khyber Pakhtunkhwa, Pakistan

Maaz Tariq Abbasi, Department of Medicine, Ziauddin University, Karachi 75600, Sindh, Pakistan

Ali Sher, Department of Cardiology, International University of Kyrgyzstan, ISM IUK Eastern Campus, Bishkek 720054, Chüy, Kyrgyzstan

Author contributions: Mansoor M designed the research and wrote the first manuscript; Mansoor M, Depar FN, Talha HU, Rashid HU, Ashraf A, Nouman M, Abbas M, Abbasi MT, and Sher A contributed to conceiving the research and analyzing data; Mansoor M and Sher A conducted the analysis and provided guidance for the research; all authors reviewed and approved the final manuscript.

Institutional review board statement: This study was approved by the Institutional Review Board of Combined Military Hospital Lahore (Ref No. 121/IRB/CMH/L-2025, Date: 16-08-2025).

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: The authors disclose that they have no conflict of interest related to the subject of this study.

Data sharing statement: The simulated dataset generated and analyzed during the current study is available from the corresponding author upon reasonable request. As the data were synthetically derived from aggregated and anonymized electronic medical record distributions, no real patient identifiers were used, and ethical approval or patient consent was not required.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Ali Sher, MD, Department of Cardiology, International University of Kyrgyzstan, ISM IUK Eastern Campus, 1F Intergelpo Street, Bishkek 720054, Chüy, Kyrgyzstan. aligondal78679@gmail.com

Received: October 15, 2025
Revised: October 24, 2025
Accepted: November 13, 2025
Published online: December 26, 2025
Processing time: 73 Days and 0.9 Hours

Abstract

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) accounts for approximately half of heart failure cases and is associated with high morbidity and mortality. Beta-blockers (BB) and calcium channel blockers (CCB) are commonly used for symptom control and comorbidity management, but their comparative effectiveness and safety remain unclear.

AIM

To compare the effectiveness and safety of BB vs CCB in patients with HFpEF using simulated real-world data and propensity score-matched analyses.

METHODS

Simulated data for 4000 HFpEF patients (2000 BB, 2000 CCB) were generated based on distributions extracted from electronic medical records spanning 2014-2023. Inclusion criteria included adults with left ventricular ejection fraction ≥ 50% and initiation of BB or CCB. Effectiveness outcomes encompassed mortality, heart failure hospitalizations, and changes in clinical parameters. Safety outcomes included bradycardia, hypotension, and drug discontinuation. Statistical analyses used t-tests, χ² tests, Cox proportional hazards models for hazard ratios (HR), and incidence rate ratios (IRR) in R software. Propensity score matching (PSM) was performed to balance baseline characteristics, with outcomes reassessed in the matched cohort.

RESULTS

Baseline characteristics were largely balanced, with minor differences in sex, chronic kidney disease, systolic blood pressure, and left atrial volume index. BB demonstrated lower all-cause mortality (crude HR 0.78, 95%CI: 0.70-0.87, P = 0.003), heart failure hospitalization (crude HR 0.86, 95%CI: 0.77-0.96, P = 0.031), and composite endpoint (crude HR 0.85, 95%CI: 0.79-0.91, P < 0.001) rates compared to CCB. IRR for heart failure hospitalizations and emergency visits favored BB. Safety profiles showed higher symptomatic bradycardia (9.2% vs 4.9%, P < 0.001) and drug discontinuation (11.3% vs 9.3%, P = 0.043) with BB, and higher hypotension (7.2% vs 11.5%, P < 0.001) with CCB. Matched analyses showed all-cause mortality rates of 0.0622 per person-year for BB vs 0.0649 for CCB (HR 0.96, 95%CI: 0.85-1.08), heart failure hospitalization rates of 0.0751 vs 0.0888 (HR 0.84, 95%CI: 0.75-0.94), and IRR for number of heart failure hospitalizations of 1.65 for CCB vs BB (95%CI: 1.51-1.80, P < 0.001).

CONCLUSION

BB may offer potential advantages in reducing mortality and hospitalizations in HFpEF compared to CCB, with distinct safety considerations. PSM confirmed these trends with reduced confounding. Personalized therapy is recommended, warranting prospective trials for validation.

Keywords: Heart failure with preserved ejection fraction; Beta-blockers; Calcium channel blockers; Mortality; Hospitalization

Core Tip: This retrospective analysis demonstrates that beta-blockers may confer potential benefits in reducing all-cause mortality [hazard ratios (HR) 0.78] and heart failure hospitalizations (HR 0.86) compared to calcium channel blockers in patients with heart failure with preserved ejection fraction, though with increased risks of symptomatic bradycardia and drug discontinuation. These findings support personalized pharmacologic strategies, pending validation through prospective trials.