Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May 12;12(5):e8069.
doi: 10.7759/cureus.8069.

Nifedipine and Amlodipine Are Associated With Improved Mortality and Decreased Risk for Intubation and Mechanical Ventilation in Elderly Patients Hospitalized for COVID-19

Affiliations
Free PMC article

Nifedipine and Amlodipine Are Associated With Improved Mortality and Decreased Risk for Intubation and Mechanical Ventilation in Elderly Patients Hospitalized for COVID-19

Isaac Solaimanzadeh. Cureus. .
Free PMC article

Abstract

Dihydropyridine calcium channel blockers (CCB) are typically used agents in the clinical management of hypertension. Yet, they have also been utilized in the treatment of various pulmonary disorders with vasoconstriction. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been implicated in the development of vasoconstrictive, proinflammatory, and pro-oxidative effects. A retrospective review was conducted on CCB use in hospitalized patients in search of any difference in outcomes related to specific endpoints: survival to discharge and progression of disease leading to intubation and mechanical ventilation. The electronic medical records for all patients that tested positive for SARS-CoV-2 that were at or above the age of 65 and that expired or survived to discharge from a community hospital in Brooklyn, NY, between the start of the public health crisis due to the viral disease up until April 13, 2020, were included. Of the 77 patients that were identified, 18 survived until discharge and 59 expired. Seven patients from the expired group were excluded since they died within one day of presentation to the hospital. Five patients were excluded from the expired group since their age was above that of the eldest patient in the survival group (89 years old). With 65 patients left, 24 were found to have been administered either amlodipine or nifedipine (CCB group) and 41 were not (No-CCB group). Patients treated with a CCB were significantly more likely to survive than those not treated with a CCB: 12 (50%) survived and 12 expired in the CCB group vs. six (14.6%) that survived and 35 (85.4%) that expired in the No-CCB treatment group (P<.01; p=0.0036). CCB patients were also significantly less likely to undergo intubation and mechanical ventilation. Only one patient (4.2%) was intubated in the CCB group whereas 16 (39.0%) were intubated in the No-CCB treatment group (P<.01; p=0.0026). Nifedipine and amlodipine were found to be associated with significantly improved mortality and a decreased risk for intubation and mechanical ventilation in elderly patients hospitalized with COVID-19. Further clinical studies are warranted. Including either nifedipine or amlodipine in medication regimens for elderly patients with hypertension hospitalized for COVID-19 may be considered.

Keywords: amlodipine; calcium channel blockers; coronavirus disease (covid-19); covid-2019; high altitude pulmonary edema; hypoxia; nifedipine; pulmonary artery hypertension; pulmonary vasoconstriction; pulmonary vasodilation.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Percent Survival Vs. CCB and No-CCB Groups
CCB = Calcium Channel Blocker (Nifedipine or Amlodipine). No-CCB = Not on Calcium Channel Blocker.
Figure 2
Figure 2. Percent of Patients Not Intubated by CCB Group
CCB = Calcium Channel Blocker (Nifedipine or Amlodipine). No-CCB = No Calcium Channel Blocker.

Similar articles

See all similar articles

References

    1. Coronavirus disease 2019 (COVID-19) infection and renin angiotensin system blockers. Bavishi C, Maddox TM, Messerli FH. JAMA Cardiol. 2020;[Epub ahead of print] - PubMed
    1. Covid-19 does not lead to a “typical” acute respiratory distress syndrome. Gattinoni L, Coppola S, Cressoni M, Busana M, Rossi S, Chiumello D. Am J Respir Crit Care. 2020;[Epub ahead of print] - PMC - PubMed
    1. COVID-19 pneumonia: ARDS or not? Gattinoni L, Chiumello D, Rossi S. Crit Care. 2020;2020:154. - PMC - PubMed
    1. Comparative effects of nifedipine, verapamil, and diltiazem on experimental pulmonary hypertension. Young TE, Lundquist LJ, Chesler E, Weir K. Am J Cardiol. 1983;51:195–200. - PubMed
    1. Nifedipine dilates the pulmonary vasculature without producing symptomatic systemic hypotension in upright resting and exercising patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease. Muramoto A, Caldwell J, Albert RK, Lakshminarayan S, Butler J. https://www.atsjournals.org/doi/abs/10.1164/arrd.1985.132.5.963 Am Rev Respir Dis. 1986;132:0. - PubMed

LinkOut - more resources

Feedback