Comparison Of Beta-Blockers Vs. Calcium Channel Blockers In Reducing Cardiovascular Mortality In Heart Failure With Preserved Ejection Fraction (HFPEF): A Meta-Analysis

Background: Heart Failure with Preserved Ejection Fraction (HfpEF) is a growing health challenge, particularly among older adults.While pharmacological treatments have proven effective for Heart Failure with Reduced Ejection Fraction (HfrEF), the benefits of specific drug classes, such as Beta-Blockers and Calcium Channel Blockers (CCBs), in HfpEF remain uncertain.Understanding the comparative effectiveness of these medications in reducing cardiovascular mortality is critical, given the distinct pathophysiological mechanisms in HfpEF.Objective:This meta-analysis aims to evaluate and compare the impact of Beta-Blockers and Calcium Channel Blockers on cardiovascular mortality in patients with HfpEF, providing insights into optimal treatment strategies for this condition.Methods:A systematic literature search was conducted in PubMed, Scopus, and Google Scholar databases for studies published between September 2017 to October 2023.Ten studies, including randomized controlled trials and observational studies, with a combined sample size of 63,650 HfpEF patients and follow-up periods ranging from 2 to 5 years, were analyzed.The primary outcomes were cardiovascular mortality, ischemic stroke, and all-cause mortality.Hazard ratios (HRs) and 95% confidence intervals (Cis) were calculated using a random-effects model.Results:Beta-blockers were associated with a significant 15% reduction in cardiovascular mortality compared to CCBs (HR: 0.85, 95% CI: 0.75-0.92,p < 0.001).Additionally, Beta-Blockers reduced the risk of ischemic stroke by 22% (HR: 0.78, 95% CI: 0.72-0.84,p < 0.001).However, Beta-Blockers also increased the risk of major bleeding by 20% (HR: 1.20, 95% CI: 1.10-1.30,p < 0.001).Subgroup analyses revealed consistent mortality benefits across different Beta-Blockers, with variability in bleeding risks between agents. Conclusion:-blockers demonstrate superior efficacy in reducing cardiovascular mortality and ischemic stroke in HfpEF patients compared to Calcium Channel Blockers.However, the increased risk of major bleeding with Beta-Blockers necessitates careful patient selection, particularly for those with a higher risk of bleeding.These findings suggest that Beta-Blockers should be considered a first-line treatment option for HfpEF, though individualized treatment plans are essential to mitigate bleeding risks.Further research is warranted to explore strategies that optimize the benefits of Beta-Blockers while minimizing adverse effects.