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

Table 1 Baseline characteristics by treatment group before propensity score matching

Category	Variable	BB (n = 2000)	CCB (n = 2000)	P value
Demographics	Age (years, mean ± SD)	70.1 ± 9.8	70.3 ± 9.8	0.587
	Sex (male, %)	37.1	41.7	0.004
	BMI (kg/m2, mean ± SD)	28 ± 5.2	28 ± 5.1	0.992
	Smoking (current/former/never, %)	20/28.2/51.8	21.8/30.2/48	0.059
Comorbidities	Hypertension (%)	79.5	80.2	0.581
	Diabetes (%)	38.9	36.4	0.103
	Coronary artery disease (%)	28.4	29	0.727
	Atrial fibrillation (%)	24.2	23.4	0.552
	Chronic kidney disease (%)	22.1	19.2	0.024
	COPD (%)	15.2	13.5	0.114
	Dyslipidemia (%)	57.8	60.4	0.108
Clinical Parameters	Heart rate (bpm, mean ± SD)	74.8 ± 14.9	75.4 ± 14.5	0.214
	SBP (mmHg, mean ± SD)	129.5 ± 20	130.9 ± 19.8	0.026
	DBP (mmHg, mean ± SD)	74.4 ± 9.9	74.8 ± 10.4	0.215
	NYHA class (I/II/III/IV, %)	10.3/37.1/41.7/10.8	10.2/38.1/40.9/10.7	0.933
Echocardiographic	LVEF (%, mean ± SD)	54.9 ± 5	55.2 ± 4.9	0.100
	LAVI (mL/m2, mean ± SD)	39.6 ± 10	40.6 ± 9.9	0.001
	E/e’ ratio (mean ± SD)	12 ± 3.9	12.1 ± 4.1	0.407
	RVSP (mmHg, mean ± SD)	35.1 ± 10	34.7 ± 10.2	0.344
Laboratory	Creatinine (mg/dL, mean ± SD)	1.2 ± 0.5	1.2 ± 0.5	0.569
	eGFR (mL/min/1.73 m2, mean ± SD)	59.3 ± 19.9	60.2 ± 20.2	0.181
	BNP (pg/mL, mean ± SD)	557.8 ± 530	557.4 ± 471	0.982
	Hemoglobin (g/dL, mean ± SD)	13.1 ± 1.9	13 ± 2.1	0.125

BMI: Body mass index; COPD: Chronic obstructive pulmonary disease; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; NYHA: New York Heart Association; LVEF: Left ventricular ejection fraction; LAVI: Left atrial volume index; RVSP: Right ventricular systolic pressure; eGFR: Estimated glomerular filtration rate; BNP: B-type natriuretic peptide; BB: Beta-blockers; CCB: Calcium channel blockers.

Table 2 Comparative effectiveness outcomes of beta-blockers vs calcium channel blockers

Outcome	BB	CCB	Statistic	P value
All-cause mortality (rate/person-year)	0.057	0.066	HR 0.78	0.003
Cardiovascular mortality	0.033	0.039	HR 0.81	0.070
HF hospitalization	0.074	0.088	HR 0.86	0.031
Number of HF hospitalizations (mean)	-	-	IRR 1.39	< 0.001
ED visits for HF (mean)	-	-	IRR 1.24	< 0.001
Composite endpoint	0.129	0.152	HR 0.85	< 0.001
Change in NYHA (mean ± SD)	-0.001 ± 0.77	-0.004 ± 0.78	t-test	0.240
Change in BNP (pg/mL, mean ± SD)	76.0 ± 109.7	83.0 ± 120.4	t-test	0.162
Change in HR (bpm, mean ± SD)	-9.9 ± 5.0	-5.1 ± 5.0	t-test	< 0.001
Change in SBP (mmHg, mean ± SD)	-4.7 ± 9.8	-10.0 ± 10.2	t-test	< 0.001

This table summarizes the primary and secondary effectiveness outcomes over the follow-up period. Time-to-event outcomes are reported as incidence rates (events per person-year) and compared using the crude hazard ratio. Count outcomes [number of heart failure (HF) hospitalizations, Emergency Department visits for HF] are presented using the incidence rate ratio from Poisson generalized linear models, with the beta-blocker group as the reference. Changes in continuous measures from baseline to follow-up are reported as mean ± SD and compared via t-tests. HF: Heart failure; HR: Hazard ratio; IRR: Incidence rate ratio; ED: Emergency department; NYHA: New York Heart Association; BNP: B-type Natriuretic Peptide; HR: Heart rate; SBP: Systolic blood pressure; BB: Beta-blockers; CCB: Calcium channel blockers.

Table 3 Balance of baseline characteristics after propensity score matching, mean (SD)

Variable	BB group (0) (n = 1733)	CCB group (1) (n = 1733)	SMD
Demographics
Age	70.25 (9.70)	70.26 (9.70)	0.001
Sex (male)	0.40 (0.49)	0.37 (0.48)	0.059
BMI	27.93 (5.17)	27.96 (5.19)	0.006
Smoking (%)			0.037
Current	417 (22.8)	391 (21.4)
Former	519 (28.4)	518 (28.4)
Never	890 (48.7)	917 (50.2)
Comorbidities
Hypertension	0.79 (0.40)	0.79 (0.41)	0.001
Diabetes	0.35 (0.48)	0.36 (0.48)	0.026
Coronary artery disease	0.27 (0.44)	0.27 (0.44)	0.002
Atrial fibrillation	0.23 (0.42)	0.23 (0.42)	0.005
Chronic kidney disease	0.20 (0.40)	0.21 (0.41)	0.035
COPD	0.14 (0.35)	0.15 (0.36)	0.03
Dyslipidemia	0.60 (0.49)	0.58 (0.49)	0.039
Clinical/Echo/Lab
Heart rate	75.47 (14.34)	74.83 (14.71)	0.044
SBP	130.33 (19.67)	129.94 (19.80)	0.02
DBP	74.59 (10.55)	74.40 (9.75)	0.018
NYHA class (%)			0.014
I (1)	201 (11.0)	201 (11.0)
II (2)	685 (37.5)	675 (37.0)
III (3)	745 (40.8)	757 (41.5)
IV (4)	195 (10.7)	193 (10.6)
LVEF	55.12 (4.83)	55.03 (5.03)	0.018
LAVI	40.61 (9.59)	39.86 (10.28)	0.076
E/e' ratio	12.12 (4.15)	12.12 (3.91)	0.001
RVSP	34.69 (10.33)	35.09 (10.13)	0.038
Creatinine	1.22 (0.51)	1.21 (0.49)	0.006
eGFR	59.80 (20.28)	59.25 (19.67)	0.028
BNP	561.34 (454.66)	561.68 (524.02)	0.001
Hemoglobin	13.05 (2.11)	13.08 (1.90)	0.013

BMI: Body mass index; COPD: Chronic obstructive pulmonary disease; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; NYHA: New York Heart Association; LVEF: Left ventricular ejection fraction; LAVI: Left atrial volume index; RVSP: Right ventricular systolic pressure; eGFR: Estimated glomerular filtration rate; BNP: B-type natriuretic peptide; BB: Beta-blockers; CCB: Calcium channel blockers.

Table 4 Comparative safety outcomes of beta-blockers vs calcium channel blockers

Outcome	BB (%)	CCB (%)	P value
Symptomatic bradycardia	9.2	4.9	0.000
Hypotension	7.2	11.5	0.000
Syncope	4.6	3.5	0.110
Worsening renal function	6.8	8.0	0.147
Drug discontinuation	11.3	9.3	0.043
Hospitalization due to ADR	5.1	5.6	0.623

This table displays the incidence of predefined safety endpoints in the beta-blocker and calcium channel blocker groups, expressed as the percentage (%) of patients experiencing the event. Safety outcomes were evaluated as proportions, with statistical comparisons conducted using χ² tests. BB: Beta-blockers; CCB: Calcium channel blockers; ADR: Adverse reaction.